Indigo Carmine and Indocyanine Green Combination

The combination of indigo carmine and indocyanine green (ICG) is used as a dual staining method in various medical procedures. This approach was developed to overcome limitations of using either dye alone. The combination maintains the advantages of fluorescence imaging with ICG while adding the direct visualization benefits of indigo carmine blue dye[1][2]. One specific application is the Combined mixed dye and fluorescence (CMF) method, which mixes indigo carmine blue dye with ICG for sentinel lymph node (SLN) biopsy in breast cancer surgery. This method allows for direct visualization of SLNs under shadowless surgical light conditions, which is facilitated by the addition of the blue dye[1]. Another application is Virtual-assisted lung mapping using dual staining (VAL-MAP DS), which combines ICG and indigo carmine to increase detectable markings during lung surgery. This approach helps overcome the problem of invisible or unidentifiable markings that can occur with single-dye methods[7]. The combination has also been used in hepatic segment identification, where concomitant injection of indigo carmine solution with a small amount of ICG (0.25 mg) can enhance the success rate of identifying liver segments, especially in patients with cirrhosis or those with livers covered by thick connective tissues due to previous surgery[5].

Other names

dual staining methodCMF methodVAL-MAP DS