Abstract / Summary
This study aimed to evaluate the feasibility and potential utility of indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging technology in guiding the debridement of nonperfused tissue during emergency surgery for testicular rupture in children. This study included 10 children with testicular rupture who underwent emergency surgery at our hospital between July 2023 and December 2025. All the children received intravenous injections of ICG (0.2 mg/kg) during the operation, and real-time angiography was performed using a near-infrared fluorescence imaging system to delineate the boundaries of nonperfused tissue, guiding the selective resection of nonperfused tissue. Finally, depending on the tissue defect, tunica albuginea suture or tunica vaginalis repair was performed. Surgical outcomes were evaluated by comparing testicular volume and Color Doppler flow imaging (CDFI) immediately after surgery and at three months after surgery. Intraoperative ICG fluorescence imaging delineated the boundary between areas of non-detectable and detectable fluorescence in all patients. The fluorescence findings were incorporated into the integrated intraoperative assessment and were used to guide selective excision of tissue considered nonviable. With a median follow-up of 10 months (range 3 to 32 months), all testes showed regular morphology and homogeneous echogenicity on grayscale ultrasound, and CDFI showed normal blood flow signals. No postoperative complications were documented in the available clinical records during the follow-up period. Preliminary data suggest that ICG-NIRF imaging is a feasible visual adjunct for visualizing tissue perfusion during emergency surgery and was not associated with any observed adverse events in this small cohort. While promising, these findings require validation in larger, controlled studies to determine its impact on long-term outcomes.