NIR/ICG – Near-Infrared Fluorescence

Fluorescence Imaging

Your Real-Time Guide for Everyday Use

In endoscopic surgery, detecting structures earlier and differentiating them better is a necessity. The imaging technology has to replace the missing view of the open site. Alongside an optimal image, it is helpful to receive additional information that increases the precision of the surgical technique. This information is supplied by NIR/ICG fluorescence imaging – an OPAL1® technology from KARL STORZ.

The use of indocyanine green (ICG), a non-radioactive, inexpensive fluorescent dye, together with light at wavelengths in the near infrared range (NIR) permits visualizing anatomic structures, perfusion and perfusion defects as well as the lymphatic system. The high penetration depth of NIR light allows visualizing the distribution of ICG up to a depth of 10 mm below the tissue surface. In liver surgery, the system is used to visualize liver metastases or primary tumors of the liver.

In response to the current professional interest in the topic – in 2015 alone, more than 600 publications were published on ICG (NCBI database) – the OPAL1® technology for NIR/ICG will continue to steadily adapt to market demands. Due to its versatile cross-discipline applications, KARL STORZ considers this fluorescence technology as a future standard imaging technique that will be found in every OR.

IMAGE1 S™ Rubina – mORe to discover

The new IMAGE1 S™ RUBINA imaging technology from KARL STORZ combines 3D and 4K technology as well as fluorescence imaging with NIR/ICG to supports surgeons’ work by supplying the highest-quality information.



  • Native 4K resolution
  • S-Technologies
  • Brilliant image quality and natural color rendering
  • 3D technology
  • Automatic horizon control
  • Improved 3D image quality
  • OPAL1® NIR/ICG technology
  • New NIR/ICG modes
  • Laser-free LED light source
  • Constant light intensity

Green or Blue – You Decide!

The OPAL1® technology for NIR/ICG now comes with a new color option. The preferred color can be selected on IMAGE1 S™ before or during the procedure.

NIR/ICG imaging in green offers high-intensity fluorescence with clear differentiation from the surrounding tissue. It additionally achieves slight optical brightening of the background.*

In comparison, NIR/ICG imaging in blue delivers fluorescence visualization that appears more balanced to the eyes, particularly for the well-perfused liver. In the process, potential overexposure of the signal in highly fluorescent areas is avoided.

*The SPECTRA A visualization mode is not available with green.

Color comparison using an example from urology (fluorescent lymph node)*

Standard white light; source: Dr. Miguel Ramirez Backhaus, Fundación IVO, Valencia, Spain
NIR/ICG imaging in green; source: Dr. Miguel Ramirez Backhaus, Fundación IVO, Valencia, Spain
NIR/ICG imaging in blue; source: Dr. Miguel Ramirez Backhaus, Fundación IVO, Valencia, Spain

*The approval status of the fluorescent dye may vary. Before using it, please determine the status applicable at your hospital or in your country.

  • Image quality
    Most surgery is performed under white light. We deliver razor-sharp FULL HD images for all white light applications as well as our S-Technologies.
  • Safety
    Our technology is Xenon-based. This eliminates the need for additional laser safety precautions such as, for example, laser safety goggles or laser protection officers in the operating room.
  • Modularity with our all-in-one solution
    Based on our IMAGE1 S™ camera platform, we provide a modular system that offers forward and backward compatibility and, consequently, sustainability. In accordance with individual needs, the system can be expanded at any time and various modules such as, for example, components for both open and laparoscopic procedures can be used simultaneously in one camera system.
  • German quality
    As a system provider, the company combines years of experience in endoscopy with software solutions that ultimately provide brilliant visualization. Furthermore, we have been working very intensively for many years on various fluorescence procedures, e.g., NIR/ICG fluorescence imaging.

  • Virtual support thanks to SCENARA® .store

    SCENARA® .store provides better orientation for user documentation. With its preview and navigation options, SCENARA® .store permits easy retrieval and playback of, for example, fluorescence sequences for consultations with patients or team meetings and thus eliminates tedious searching.
    In addition, the software offers many other benefits such as, for example, the possibility to edit, cut, compare and export video and image material as well as seamless storage in existing information and archiving systems. 


  • Service
    KARL STORZ is synonymous with quality products and offers a first-class service. We are always there for you when you need us!
    As a manufacturer of endoscopes with countless years of experience, we have a global presence and are at your disposal at any time.


Visualization of Perfusion

Perfusion assessment is important in various medical disciplines. With NIR/ICG technology and the administration of ICG, ischemic areas can be displayed in real time more easily and efficiently, or perfusion can be examined, for instance in anastomoses. This enables the surgeon to take intraoperative action.

Example applications:

  • Rapid perfusion assessment of a planned resection zone as well as of the subsequent anastomosis, e.g., in colon1 or esophageal resection and gastric bypass2.
  • Perfusion assessment of flap plasty in open surgery
  • Visualization of liver segments3
  • Multidisciplinary use in laparoscopic, endoscopic, and open surgery


1Koh et al., Fluorescent Angiography Used to Evaluate the Perfusion Status of Anastomosis in Laparoscopic Anterior Resection, 2016

2Boni et al., Clinical Applications of Indocyanine Green (ICG) Enhanced Fluorescence in Laparoscopic Surgery, 2015

3Diana M et al Superselective Intra-Arterial Hepatic Injection of Indocyanine Green (ICG) for Fluorescence Image-Guided Segmental Positive Staining: Experimental Proof of the Concept. 2017

Visualization of the Biliary Tree Anatomy

Due to its hepatobiliary excretion, ICG collects in the gallbladder and bile ducts. This allows the rapid and reliable identification of the biliary anatomy, for instance in cholecystectomy.

Example applications:

  • Reduced surgical duration with ICG when compared to standard cholangiographies.1 Facilitated differentiation between cystic duct and common bile duct.2
  • Display of intraoperative bile leakage with ICG, e.g., following partial hepatectomy


1Dip et al., Cost analysis and effectiveness comparing the routine use of intraoperative fluorescent cholangiography with fluoroscopic cholangiogram in patients undergoing laparoscopic cholecystectomy, 2014

2Boni et al., ICG-Enhanced Fluorescence-Guided Laparoscopic Surgery, Doctor-to-Doctor Manual ENDO-PRESS®, (ISBN 978-3-89756-934-8)

Visualization of Hepatocellular Carcinoma and Metastases

Primary liver tumors are the sixth most common type of cancer worldwide, and metastases to the liver are even 20 times more common than primary liver tumors.1 For liver surgery, NIR/ICG technology in combination with ICG offers many advantages.

  • Intraoperative visualization of metastases and hepatocellular carcinoma on or below the liver surface2
  • Diagnostics of superficial or near-surface micrometastases down to the millimeter range3
  • Easier definition of resection borders4
  • Visualization of liver segments*


1Cancer in Germany 2011/2012 (10th edition), Robert Koch Institute, Berlin

2Visualization of ICG up to a depth of one centimeter, depending on the tissue composition

3Tummers et al., First experience on laparoscopic near-infrared fluorescence imaging of hepatic uveal melanoma metastases using indocyanine green, 2014

4Boni et al., ICG-Enhanced Fluorescence-Guided Laparoscopic Surgery, Doctor-to-Doctor Manual ENDO-PRESS®, (ISBN 978-3-89756-934-8)

Visualization of the Lymphatic System

The reliable identification of the lymphatic system or the sentinel lymph node represents a challenge in many oncological procedures. The use of ICG* in these procedures permits the real-time visualization of the entire lymphatic system draining the tumor. Nuclear medicine imaging can therefore be avoided.1

Example applications:

  • Non-radioactive method for lymph node visualization
  • Detection rates compare favorably with established methods of lymph node visualization2
  • Localization of lymphatic leakages3
  • Multidisciplinary use, for instance in gynecology, urology, and general surgery


*The approval status of the drug may vary. Before using it, please determine the status applicable at your hospital or in your country.

1Papadia A. et al., ICG-Enhanced Fluorescence-Guided SLN Mapping in Gynecological Malignancies, Doctor-to-Doctor Manual ENDO-PRESS®, (ISBN 978-3-89756-932-4)

2Imboden et al., A Comparison of Radiocolloid and Indocyanine Green Fluorescence Imaging, Sentinel Lymph Node Mapping in Patients with Cervical Cancer Undergoing Laparoscopic Surgery, 2015

3Papadia A et al. Indocyanine Green Fluorescence Imaging in the Surgical Management of an Iatrogenic Lymphatic Fistula: Description of a Surgical Technique, 2015