Indocyanine Green (ICG) Fluorescence-Guided Surgery (FGS) has emerged as an advanced intraoperative imaging modality that enhances real-time visualization of tissue perfusion, lymphatic drainage, and anatomical structures in colorectal surgery. Anastomotic leakage remains a major postoperative complication strongly associated with impaired microvascular perfusion. ICG imaging improves intraoperative decision-making by enabling objective perfusion assessment compared with conventional subjective evaluation. Contemporary evidence demonstrates reduced anastomotic leak rates and improved oncological precision with ICG use. Recent advancements have shifted the field toward quantitative ICG (qICG) perfusion metrics and artificial intelligence-assisted fluorescence analysis, improving reproducibility and standardization. Despite promising results, variability in protocols, lack of universal thresholds, and equipment dependency remain key limitations. Ongoing technological integration is expected to further enhance surgical precision and outcomes.
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