Role of Indocyanine Green in Minimizing Post-operative Bleeding

ICG for Liver Function Assessment and Surgical Planning

The European Association for the Study of the Liver recommends using the ICG retention test (ICG-R15) as a non-invasive predictor of portal hypertension and liver function, helping to determine the safe extent of liver resection and minimize bleeding risk in patients undergoing hepatectomy 1, 2
Various ICG-R15 cutoffs guide decision-making for hepatectomy procedures in cirrhotic patients, with the American Association for the Study of Liver Diseases suggesting limiting resection to patients with ICG-R15 below 20-25% and segmentectomy to those below 30-35% 1
ICG clearance correlates with perioperative mortality and helps determine the maximum extent of resection according to Makuuchi criteria, as suggested by the European Society of Surgical Oncology 2
The International Hepato-Pancreato-Biliary Association recommends combining ICG kinetics with other liver function parameters (Child-Pugh, MELD, liver stiffness measurement) to improve patient selection and reduce the risk of post-hepatectomy liver failure and associated bleeding complications 1, 3

The American College of Surgeons suggests that ICG should be considered an adjunct to, not a replacement for, standard surgical techniques for preventing bleeding 4