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Intraoperative Visualization Agents

Visualization agents — fluorescent dyes, visible dyes, and photosensitizers — enable intraoperative tissue identification, perfusion assessment, lymphatic mapping, tumor detection, and fistula / leak localization in urology and urogynecology. Indocyanine green (ICG) is the dominant agent and has transformed robotic urologic surgery through integration with near-infrared (NIR) fluorescence platforms (Firefly, SPY, PINPOINT, Rubina).[1][2] This article is the clinical-application hub — procedures and evidence by indication. For agent-level pharmacology, dosing, and imaging-hardware compatibility, see the dedicated pages in the Tools tree:

For adjacent topics, see Visualization Agents index (Tools) and Robotics platforms.

Agent quick-reference​

AgentClassDetectionExcretionPrimary urologic role
ICGTricarbocyanine NIR fluorophoreNIR camera (Firefly / SPY)HepaticPerfusion, SLN mapping, renal tumor ID, ureter adventitial mapping[3]
Methylene bluePhenothiazine visible dyeWhite light ± NIRRenalUreteral ID, fistula localization[4]
Indigo carmineVisible dyeWhite lightRenalHistorical gold-standard ureteral jet — unavailable since 2014[5]
Sodium fluoresceinVisible / UV dyeWhite light / cobalt-blueRenal (rapid)Ureteral jet visualization post-indigo-carmine era[6][7]
Pudexacianinium (ASP-5354)Renally-excreted ICG derivative, NIRNIR cameraRenalInvestigational IV ureteral visualization[8][9]
Hexaminolevulinate (Cysview)PDD photosensitizerBlue-light cystoscopeN/ABladder-cancer detection[10][11]
5-ALAPDD photosensitizerBlue-light cystoscopeN/ABladder-cancer detection (oral or intravesical)[12]
Oral phenazopyridineAzo dye (non-fluorescent)White-light cystoscopeRenalUreteral jet aid; cheapest first-line[13]
Rizedisben (Illuminare-1)Myelin-binding fluorophoreBlue-light camera—Investigational nerve-specific imaging[14]

Robot-assisted partial nephrectomy (RAPN) — ICG's flagship urologic application​

Meta-analytic evidence​

Giulioni 2023 meta-analysis (8 prospective studies, n = 535):[15]

  • ICG-guided RAPN — lower warm ischemia time (WMD −2.05 min; p = 0.011)
  • Better postoperative eGFR preservation (WMD +7.67 mL/min; p = 0.002)
  • No difference in positive surgical margin rates or tumor recurrence

Diana 2020 TRoNeS multi-institutional series (n = 318): ICG confirmed as a reliable tool for guiding surgical strategy, particularly in cases with challenging vascularization or impaired renal function. Trifecta 79.9%; MIC 71.7%.[3]

Three distinct intraoperative functions​

FunctionTechniqueEvidence
Tumor identificationMalignant renal tumors are typically hypofluorescent (dark) against brightly fluorescent normal parenchyma; benign tumors range from iso- to hyperfluorescentTobis 2011 — 7/10 malignant tumors hypofluorescent; 3 isofluorescent[16][17]
Selective arterial clampingICG injection after selective clamp confirms ischemic zone; enables superselective ischemia preserving uninvolved parenchymaHarke 2014 matched-pair — eGFR loss 5.1 vs 16.1 mL/min selective vs global (p = 0.045)[18]
Endophytic tumor markingPreoperative superselective transarterial ICG-lipiodol embolization tags totally endophytic masses for intraoperative NIRF identificationSimone 2019 and Nardis 2022 — 63.4% well-defined margins + 34.1% blurred margins; 100% technical success[19][20]

Sentinel lymph node (SLN) mapping​

Penile cancer — strongest SLN evidence​

EAU/ASCO 2023 guideline recommends dynamic sentinel node biopsy (DSNB) as the preferred surgical staging for cN0 patients with ≥T1b tumors.[21]

  • Dell'Oglio 2020 n = 400 patients / 740 groins — hybrid ICG-⁹⁹ᵐTc-nanocolloid localized all pre-op-defined SNs; fluorescence detected 96% of all excised SNs and yielded a 39% higher detection rate than blue dye (p < 0.001)[22]
  • Zhang 2023 meta-analysis — ICG-NIR for SLN metastasis in penile cancer: 100% pooled sensitivity; specificity 2%[23]

Prostate cancer​

  • Manny 2014 (n = 50) — percutaneous robotic-guided ICG injection identified SLNs in 76% with 100% sensitivity and NPV for nodal metastasis[24]
  • Li 2025 (n = 34) — cystoscopic ICG injection — fluorescence detection 97.1%, 100% per-patient sensitivity and NPV; best performance in low-to-intermediate-risk disease[25]
  • Wu 2019 meta-analysis (17 studies, n = 1,059 pelvic malignancies) — pooled detection rate 95% (95% CI 93–97); pooled sensitivity 86% (75–94); no ICG-related complications[26]

Radical prostatectomy — tissue marking​

ICG injected into the prostate provides tissue marking that differentiates prostate from surrounding structures (NVB, seminal vesicles, vas deferens, obturator nerve) at mean 10 min post-injection. Complementary to NeuroSAFE frozen-section nerve-sparing guidance — not a replacement.[24][27]

Ureteral identification and patency — the post-indigo-carmine era​

Indigo carmine was the gold-standard IV dye for intraoperative ureteral jet visualization for decades; unavailable since 2014 due to manufacturing shortage.[5][28] Post-2014 practice converged on several alternatives, each with trade-offs.

IV agents — during robotic or laparoscopic pelvic surgery​

AgentTechniqueDetectionTime to jetCost
Sodium fluorescein0.25–1.0 mL of 10% solution IVWhite-light cystoscope~5 min[7]Moderate
Methylene blue0.25–1.0 mg/kg IV 40 min preopWhite-light cystoscopeVariable; can be inconsistent[4][28]Low
ICG (intraureteral / stent-coated)Not by IV for intraluminal visualization — ICG is hepatically cleared; requires direct instillation or ureteral-stent coatingNIR (Firefly)Immediate on instillationModerate
Pudexacianinium (investigational)IV, renally excretedNIRDose-dependent; 100% success at 3 mg in Phase 2[9]Investigational

Oral agent​

Phenazopyridine 200 mg PO preop — orange urine aids ureteral-jet visualization under white-light cystoscopy. Cheapest first-line in the Askew 2022 cost-effectiveness model ($110/patient).[13] Slower excretion (~82 min) than sodium fluorescein (~5 min).[29]

Bladder-distension alternative​

Mannitol bladder distension — Grimes 2017 RCT reported highest overall surgeon satisfaction for ureteral patency assessment; does not require any IV agent.[30]

RCT guidance​

Espaillat-Rijo 2016 RCT (n = 176) — sodium fluorescein and 10% dextrose significantly improved visibility and surgeon satisfaction vs saline; phenazopyridine was non-inferior for those outcomes.[31]

AUGS Consensus 2018 — acknowledges the indigo-carmine shortage, reviews sodium fluorescein and phenazopyridine as defensible alternatives, and supports cystoscopy with whatever agent is available at the time of pelvic reconstructive surgery.[28]

Methylene-blue ureteral identification during open / MIS surgery​

de'Angelis 2023 WSES IUTI guideline cites a systematic review finding 89.2% of ureters (91/102) identified with IV methylene blue (0.25–1.0 mg/kg, 40 min preop). Advantages: IV administration, no cystoscopy or stenting required. Key caveats: contraindicated in G6PD deficiency and with SSRI/MAOI (serotonin syndrome risk).[4]

Pudexacianinium — the next-generation approach​

ICG derivative engineered for renal excretion, emitting NIR at 820 nm when excited at 780 nm — enables retroperitoneal ureteral visualization through overlying peritoneum via standard NIRF camera.[8] Albert 2023 Phase 2 RCT (n = 12 colorectal) — dose-dependent success: 2/3 at 0.3 mg, 5/6 at 1.0 mg, 3/3 at 3.0 mg; one grade 1 proteinuria AE.[9] Not yet FDA-approved; combines ICG's NIR quality with methylene blue's IV-without-cystoscopy convenience.

Fistula localization​

Methylene blue remains the standard agent for vesicovaginal / ureterovaginal fistula localization — dilute MB instilled into the bladder reveals vaginal leakage on a tampon or pad. The three-swab (or double-dye) test is a classic clinical-exam adjunct combining intravesical methylene blue with oral phenazopyridine to distinguish VVF from UVF. Detailed in the clinical Vesicovaginal fistula literature.

ICG has been used in select fistula cases where NIR platforms are available, particularly for vesicouterine / uterocutaneous fistula mapping during robotic repair.

Bladder cancer detection — photodynamic diagnosis (PDD)​

Hexaminolevulinate (Cysview) and 5-aminolevulinic acid (5-ALA) are photosensitizing prodrugs — not visualization dyes in the traditional sense — enabling blue-light cystoscopy (BLC) for enhanced bladder-cancer detection.

Mechanism​

After intravesical instillation (hexaminolevulinate) or oral administration (5-ALA), the prodrug enters mucosal cells and is converted to protoporphyrin IX (PpIX), which accumulates preferentially in neoplastic cells due to altered enzymatic activity. Under blue light (360–450 nm), tumor tissue fluoresces bright red against a dark blue normal urothelial background.[10][11]

Hexaminolevulinate (Cysview) — FDA-approved​

  • Dose: 50 mL reconstituted solution instilled intravesically, retained 1 hour before cystoscopy[10]
  • Kamat 2016 meta — BLC significantly improved detection of Ta tumors (OR 4.90; 95% CI 1.94–12.39) and CIS (OR 12.37; 95% CI 6.34–24.13) vs white-light; lower 12-mo recurrence[32]
  • Maisch 2021 Cochrane — BLC-guided TURBT improves tumor detection and may reduce recurrence vs white-light; evidence quality limited[33]

5-ALA​

  • Inoue 2012 — 5-ALA fluorescence cystoscopy detected 72.1% of flat lesions (dysplasia / CIS) missed by conventional endoscopy; oral 5-ALA diagnostically equivalent to intravesical[12]
  • Ishikawa 2025 region-specific analysis — oral 5-ALA performance varies by bladder region[34]

Guideline position​

EAU guidelines strongly recommend PDD in cases of normal white-light cystoscopy with abnormal cytology.[35]

Limitations​

False-positive fluorescence can occur with inflammation, recent TURBT, or BCG therapy. Limited tissue-penetration depth.[33]

Emerging applications​

Rizedisben (Illuminare-1) — nerve-specific imaging​

Novel small-molecule fluorophore that binds myelin and fluoresces at 370–425 nm to enhance nerve visualization. Gold 2025 non-randomized clinical trial evaluated rizedisben during MIS including prostatectomy — feasibility for intraoperative identification of neurovascular bundles and obturator nerves, structures critical for functional outcomes after radical prostatectomy.[14] First nerve-specific fluorophore to enter clinical trials; could transform nerve-sparing surgery if validated in larger studies.

Ureteral reconstruction and perfusion assessment​

ICG has been used in robotic ureteral reimplantation and reconstruction to assess anastomotic perfusion and confirm tissue viability. Cacciamani 2020 expert consensus systematic review covers technique and safety in detail.[27]

Pediatric urology​

ICG-NIRF has been applied in pediatric partial nephrectomy (duplex systems, tumors), lymphatic-sparing varicocele repair, and oncologic procedures. All pediatric series report clinical safety with no systemic AEs.[36]

Safety — the comparative profile​

AgentAdverse-event profileCritical contraindications
ICGAnaphylaxis <0.15%; vagotonic reactions rareIodide allergy (contains sodium iodide); pregnancy (category C)
Methylene blueMild; rare severeG6PD deficiency (hemolysis, methemoglobinemia); serotonin syndrome with SSRIs/MAOIs
Indigo carmine (historical)Severe hypotension, hypoxia, rare cardiac arrestHemodynamic instability; CrCl <30
Sodium fluoresceinTransient skin/scleral yellowing; rare anaphylaxisKnown hypersensitivity
PudexacianiniumOne grade-1 proteinuria in Phase 2; otherwise cleanInvestigational
Hexaminolevulinate / 5-ALAPhotosensitivity 24–48 h; false-positives with inflammationPorphyria

Evidence Summary​

ApplicationEvidence levelKey source
RAPN perfusion / ischemiaLevel 1 (meta of 8 prospective)Giulioni 2023[15]; Diana 2020 TRoNeS[3]
Selective clampingLevel 2 (matched-pair)Harke 2014[18]
Endophytic tumor taggingLevel 3Simone 2019[19]; Nardis 2022[20]
Penile-cancer SLNLevel 1 (guideline + meta)EAU/ASCO 2023[21]; Dell'Oglio 2020[22]; Zhang 2023[23]
Prostate-cancer SLNLevel 2–3Manny 2014[24]; Li 2025[25]; Wu 2019 meta[26]
Ureteral-patency post-indigo-carmineLevel 1 (multiple RCTs)Espaillat-Rijo 2016[31]; Grimes 2017[30]; Askew 2022 CEA[13]
Methylene-blue ureteral IDLevel 2 (SR; WSES guideline)de'Angelis 2023[4]
PudexacianiniumLevel 2 (Phase 2 RCT)Albert 2023[9]; Fushiki 2023 preclinical[8]
Bladder-cancer BLCLevel 1 (meta + Cochrane)Kamat 2016[32]; Maisch 2021 Cochrane[33]; EAU 2022[35]
Rizedisben nerve imagingLevel 3 (non-randomized trial)Gold 2025[14]

Clinical Positioning​

  • ICG is the most versatile and widely adopted visualization agent in urologic surgery. Strong evidence supports use in RAPN (improved functional outcomes), SLN mapping (penile and prostate cancer), and tissue perfusion. Integration into the da Vinci Firefly system has made it the de facto standard for fluorescence-guided robotic urology.[3][15][27]
  • For RAPN, ICG reduces warm ischemia and improves eGFR preservation — the meta-analytic signal justifies routine use where NIRF hardware is available.[15]
  • For RAPN of endophytic tumors, preoperative ICG-lipiodol transarterial tagging is a legitimate approach per the Simone 2019 "Ride the Green Light" technique.[19]
  • For penile-cancer cN0 staging, hybrid ICG-⁹⁹ᵐTc-nanocolloid is preferred per EAU/ASCO 2023 — fluorescence detects 39% more SLNs than blue dye alone.[21][22]
  • For ureteral-patency assessment in pelvic surgery, no single agent replaces indigo carmine. Phenazopyridine is cheapest first-line; IV sodium fluorescein is fastest; mannitol bladder distension had highest surgeon satisfaction in Grimes 2017.[13][30][31]
  • Methylene blue for IV ureteral identification has G6PD and serotonin-syndrome contraindications — screen before use.[4]
  • Pudexacianinium is the likely next-generation standard for ureteral identification — combines ICG's NIR imaging quality with renal excretion that eliminates the need for cystoscopy or stenting. Not yet FDA-approved; watch for approval.[8][9]
  • Blue-light cystoscopy with hexaminolevulinate or 5-ALA is guideline-recommended for enhanced bladder-cancer detection, particularly CIS and flat lesions missed by white-light.[32][33][35]
  • Rizedisben may transform nerve-sparing surgery if validated — first myelin-binding fluorophore in clinical trials.[14]
  • ICG iodide warning is easy to miss — it contains sodium iodide; ask about shellfish / iodine allergy specifically before each case.[37]
  • Hepatic clearance of ICG means it does not appear in urine — so IV ICG cannot be used for intraluminal ureteral identification; it can be used for adventitial ureter tracing via peristaltic microvascular flow (see ICG deep-dive).

See Also​

References​

1. Licari LC, Bologna E, Proietti F, et al. "Exploring the applications of indocyanine green in robot-assisted urological surgery: a comprehensive review of fluorescence-guided techniques." Sensors. 2023;23(12):5497. doi:10.3390/s23125497

2. Fransvea P, Miccini M, Rondelli F, et al. "A green lantern for the surgeon: a review on the use of indocyanine green (ICG) in minimally invasive surgery." J Clin Med. 2024;13(16):4895. doi:10.3390/jcm13164895

3. Diana P, Buffi NM, Lughezzani G, et al. "The role of intraoperative indocyanine green in robot-assisted partial nephrectomy: results from a large, multi-institutional series." Eur Urol. 2020;78(5):743–749. doi:10.1016/j.eururo.2020.05.040

4. de'Angelis N, Schena CA, Marchegiani F, et al. "2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery." World J Emerg Surg. 2023;18(1):45. doi:10.1186/s13017-023-00513-8

5. Cohen SA, Carberry CL, Smilen SW. "American Urogynecologic Society consensus statement: cystoscopy at the time of prolapse repair." Female Pelvic Med Reconstr Surg. 2018;24(4):258–259. doi:10.1097/SPV.0000000000000529

6. Doyle PJ, Lipetskaia L, Duecy E, Buchsbaum G, Wood RW. "Sodium fluorescein use during intraoperative cystoscopy." Obstet Gynecol. 2015;125(3):548–550. doi:10.1097/AOG.0000000000000675

7. Cohen SA, Chaudhry Z, Oliver JL, et al. "Comparison of times to ureteral efflux after administration of sodium fluorescein and phenazopyridine." J Urol. 2017;197(2):519–523. doi:10.1016/j.juro.2016.07.099

8. Fushiki H, Yoshikawa T, Matsuda T, Sato T, Suwa A. "Preclinical development and validation of ASP5354: a near-infrared fluorescent agent for intraoperative ureter visualization." Mol Imaging Biol. 2023;25(1):74–84. doi:10.1007/s11307-021-01613-0

9. Albert M, Delgado-Herrera L, Paruch J, et al. "Pudexacianinium (ASP5354) chloride for ureter visualization in participants undergoing laparoscopic minimally invasive colorectal surgery." Surg Endosc. 2023;37(9):7336–7347. doi:10.1007/s00464-023-10193-9

10. US Food and Drug Administration. Cysview (hexaminolevulinate) — prescribing information. Updated 2025-12-05.

11. Casas A. "Clinical uses of 5-aminolevulinic acid in photodynamic treatment and photodetection of cancer: a review." Cancer Lett. 2020;490:165–173. doi:10.1016/j.canlet.2020.06.008

12. Inoue K, Fukuhara H, Shimamoto T, et al. "Comparison between intravesical and oral administration of 5-aminolevulinic acid in the clinical benefit of photodynamic diagnosis for non-muscle-invasive bladder cancer." Cancer. 2012;118(4):1062–1074. doi:10.1002/cncr.26378

13. Askew AL, Myers ER, Dieter AA. "Cost-effectiveness of agents used for evaluation of ureteral patency during intraoperative cystoscopy in gynecologic and urogynecologic surgery." Am J Obstet Gynecol. 2022;226(1):100.e1–100.e6. doi:10.1016/j.ajog.2021.08.055

14. Gold SA, Pere MM, Assel M, et al. "Rizedisben in minimally invasive surgery." JAMA Surg. 2025;160(8):875–883. doi:10.1001/jamasurg.2025.1987

15. Giulioni C, Mulawkar PM, Castellani D, et al. "Near-infrared fluorescence imaging with indocyanine green for robot-assisted partial nephrectomy: a systematic review and meta-analysis." Cancers. 2023;15(23):5560. doi:10.3390/cancers15235560

16. Tobis S, Knopf J, Silvers C, et al. "Near-infrared fluorescence imaging with robotic-assisted laparoscopic partial nephrectomy: initial clinical experience for renal cortical tumors." J Urol. 2011;186(1):47–52. doi:10.1016/j.juro.2011.02.2701

17. Tobis S, Knopf JK, Silvers C, et al. "Robot-assisted and laparoscopic partial nephrectomy with near-infrared fluorescence imaging." J Endourol. 2012;26(7):797–802. doi:10.1089/end.2011.0604

18. Harke N, Schoen G, Schiefelbein F, Heinrich E. "Selective clamping under the usage of near-infrared fluorescence imaging with indocyanine green in robot-assisted partial nephrectomy: a single-surgeon matched-pair study." World J Urol. 2014;32(5):1259–1265. doi:10.1007/s00345-013-1202-4

19. Simone G, Tuderti G, Anceschi U, et al. "'Ride the green light': indocyanine green-marked off-clamp robotic partial nephrectomy for totally endophytic renal masses." Eur Urol. 2019;75(6):1008–1014. doi:10.1016/j.eururo.2018.09.015

20. Nardis PG, Cipollari S, Lucatelli P, et al. "Cone-beam CT-guided transarterial tagging of endophytic renal tumors with indocyanine green for robot-assisted partial nephrectomy." J Vasc Interv Radiol. 2022;33(8):934–941. doi:10.1016/j.jvir.2022.04.016

21. Brouwer OR, Albersen M, Parnham A, et al. "European Association of Urology–American Society of Clinical Oncology collaborative guideline on penile cancer: 2023 update." Eur Urol. 2023;83(6):548–560. doi:10.1016/j.eururo.2023.02.027

22. Dell'Oglio P, de Vries HM, Mazzone E, et al. "Hybrid indocyanine green–⁹⁹ᵐTc-nanocolloid for single-photon emission computed tomography and combined radio- and fluorescence-guided sentinel node biopsy in penile cancer: results of 740 inguinal basins assessed at a single institution." Eur Urol. 2020;78(6):865–872. doi:10.1016/j.eururo.2020.09.007

23. Zhang R, Zhang Y, Dong S, et al. "Performance of indocyanine green in sentinel lymph node mapping and lymph node metastasis in penile cancer: systematic review, meta-analysis, and single-center experience." World J Urol. 2023;41(9):2319–2326. doi:10.1007/s00345-023-04485-x

24. Manny TB, Patel M, Hemal AK. "Fluorescence-enhanced robotic radical prostatectomy using real-time lymphangiography and tissue marking with percutaneous injection of unconjugated indocyanine green: the initial clinical experience in 50 patients." Eur Urol. 2014;65(6):1162–1168. doi:10.1016/j.eururo.2013.11.017

25. Li YH, Chuang YF, Ou YC, et al. "Cystoscopic ICG-guided sentinel lymph node dissection in robotic radical prostatectomy: a prospective study." Prostate. 2025. doi:10.1002/pros.70107

26. Wu Y, Jing J, Wang J, et al. "Robotic-assisted sentinel lymph node mapping with indocyanine green in pelvic malignancies: a systematic review and meta-analysis." Front Oncol. 2019;9:585. doi:10.3389/fonc.2019.00585

27. Cacciamani GE, Shakir A, Tafuri A, et al. "Best practices in near-infrared fluorescence imaging with indocyanine green (NIRF/ICG)-guided robotic urologic surgery: a systematic review-based expert consensus." World J Urol. 2020;38(4):883–896. doi:10.1007/s00345-019-02870-z

28. Cwalinski T, Polom W, Marano L, et al. "Methylene blue — current knowledge, fluorescent properties, and its future use." J Clin Med. 2020;9(11):E3538. doi:10.3390/jcm9113538

29. Hernot S, van Manen L, Debie P, Mieog JSD, Vahrmeijer AL. "Latest developments in molecular tracers for fluorescence image-guided cancer surgery." Lancet Oncol. 2019;20(7):e354–e367. doi:10.1016/S1470-2045(19)30317-1

30. Grimes CL, Patankar S, Ryntz T, et al. "Evaluating ureteral patency in the post-indigo-carmine era: a randomized controlled trial." Am J Obstet Gynecol. 2017;217(5):601.e1–601.e10. doi:10.1016/j.ajog.2017.07.012

31. Espaillat-Rijo L, Siff L, Alas AN, et al. "Intraoperative cystoscopic evaluation of ureteral patency: a randomized controlled trial." Obstet Gynecol. 2016;128(6):1378–1383. doi:10.1097/AOG.0000000000001750

32. Kamat AM, Hahn NM, Efstathiou JA, et al. "Bladder cancer." Lancet. 2016;388(10061):2796–2810. doi:10.1016/S0140-6736(16)30512-8

33. Maisch P, Koziarz A, Vajgrt J, et al. "Blue versus white light for transurethral resection of non-muscle-invasive bladder cancer." Cochrane Database Syst Rev. 2021;12:CD013776. doi:10.1002/14651858.CD013776.pub2

34. Ishikawa Y, Tanaka H, Kobayashi M, et al. "Bladder region-specific analysis of the diagnostic performance of oral 5-aminolevulinic acid fluorescence cystoscopy in non-muscle-invasive bladder cancer." Jpn J Clin Oncol. 2025;hyaf171. doi:10.1093/jjco/hyaf171

35. Compérat E, Amin MB, Cathomas R, et al. "Current best practice for bladder cancer: a narrative review of diagnostics and treatments." Lancet. 2022;400(10364):1712–1721. doi:10.1016/S0140-6736(22)01188-6

36. Esposito C, Borgogni R, Autorino G, et al. "Applications of indocyanine green-guided near-infrared fluorescence imaging in pediatric minimally invasive urologic surgery: a narrative review." J Laparoendosc Adv Surg Tech A. 2022;32(12):1280–1287. doi:10.1089/lap.2022.0231

37. US Food and Drug Administration. IC-Green (indocyanine green) — prescribing information. Updated 2026-01-30.