Fluorescence-guided surgery, so the surgeon can see what matters.
ICG and 5-ALA let a surgeon see blood flow, lymph nodes, bile ducts, ureters and residual tumour in real time.
Indicative pricing
What fluorescence guidance adds to a UK private operation.
In short
Most ICG add-ons cost £150–£800 and add 5–40 minutes to the operation.
| Agent / use | Indicative add-on | Extra theatre time | Timing |
|---|---|---|---|
| ICG add-on to routine laparoscopic/robotic case | £150–£400 | Adds 5–15 min | Same operation |
| ICG sentinel-node mapping (breast, gynae, gastric) | £300–£800 | Adds 20–40 min | Same operation |
| ICG fluorescence cholangiography | £200–£500 | Adds 5–10 min | Same operation |
| 5-ALA (Gliolan) fluorescence-guided glioma resection | £1,800–£3,500 | Included in craniotomy | Same admission |
| Pafolacianine (Cytalux) FRα-targeted probe | £4,500–£7,500 | Adds 20–40 min | Same operation |
| Consultation only | £200–£400 | 30 min | Same visit |
Prices vary by hospital, by which surgeon operates, by the platform in use (robotic Firefly, laparoscopic NIR tower or open handheld camera), and by whether the underlying operation is already booked.
The problem
The right agent, the right surgeon, the right operation.
Fluorescence guidance is oversold in some settings and underused in others. Marketing brochures rarely tell you which. We do, before you commit.
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Will it actually change the operation?
For bowel perfusion, sentinel nodes, cholangiography and 5-ALA glioma resection - yes, often. For other uses the evidence is thinner. We tell you where your case sits.
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Is the platform right?
Robotic Firefly, laparoscopic Karl Storz or Stryker towers, open handheld cameras - the platform must match the operation, not the other way round.
When it helps
Where fluorescence guidance genuinely changes an operation.
The situations where the evidence is strongest, plus the one red flag that means telling us before you go anywhere near a dye.
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Colorectal anastomosis perfusion
ICG confirms the bowel ends are well perfused before joining them - PILLAR-class evidence links it to fewer anastomotic leaks.
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Sentinel lymph node mapping
ICG lights up the first draining node in breast, endometrial, cervical and gastric cancer - often replacing radioisotope.
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Biliary anatomy in cholecystectomy
Fluorescence cholangiography shows the cystic and common bile ducts in real time, reducing the risk of a duct injury.
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Ureter identification
ICG given via a ureteric catheter makes the ureter glow - invaluable in re-operative pelvic surgery and endometriosis.
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Lymphoedema mapping and free flaps
ICG lymphography for lymphaticovenous anastomosis, and flap perfusion in reconstruction and DIEP breast surgery.
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High-grade glioma resection
5-ALA turns tumour tissue pink under blue light - the ALA-Glioma trial showed higher rates of gross-total resection.
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Ovarian and lung nodules
Pafolacianine (Cytalux) binds folate-receptor-α, lighting up additional nodules the surgeon would otherwise miss.
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Red flag: true ICG or 5-ALA allergy
Genuine anaphylaxis is rare but real.
Agent options
ICG, 5-ALA and the newer tumour-targeted probes.
What each dye actually does - and which operation it fits.
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ICG for perfusion
A small IV dose of indocyanine green (0.1–0.5 mg/kg) shows blood flow in bowel, flaps and reconstructions within seconds.
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ICG for lymphatic mapping
A peritumoural or submucosal injection maps the sentinel node in breast, gynae-oncology and gastric cancer.
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ICG cholangiography
An IV dose given 30–60 minutes before gallbladder surgery lights up the biliary tree - no cystic-duct cannulation required.
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ICG ureter mapping
ICG delivered up a ureteric catheter makes the ureter fluoresce, protecting it in complex pelvic and endometriosis surgery.
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5-ALA (Gliolan) for glioma
Taken by mouth (20 mg/kg) three hours before craniotomy. Tumour cells fluoresce pink under blue-violet light.
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Pafolacianine (Cytalux)
A folate-receptor-α targeted NIR probe for FRα-positive ovarian cancer and lung nodules - UK availability ramping.
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Panitumumab-IRDye800 and other tumour probes
Antibody-conjugated NIR dyes in head-and-neck, colorectal and breast trials - access is via clinical study only.
Safety and honest limits
What fluorescence guidance can - and cannot - do.
Fluorescence is a safe, useful tool for the right operations. The things worth planning are allergy history, dose timing, and understanding where the technique still has limits.
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ICG allergy is rare
The old "iodine or shellfish allergy" warning is a myth. True ICG anaphylaxis is very rare - under 1 in 40,000 doses - but the team is set up to manage it.
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5-ALA and light sensitivity
After 5-ALA you must avoid bright sunlight and strong theatre lights for 24 hours. The ward keeps the lights low and windows shaded.
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Transient hepatic uptake
We flag this for anyone due a scan the same day.
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False positives in inflammation
Fluorescence can light up inflamed but benign tissue. The surgeon reads the signal in context, alongside white-light appearance and touch.
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False negatives in obese tissue
Near-infrared light only travels a few millimetres. Deep or fat-covered nodes can be missed - the surgeon still checks the anatomy the old-fashioned way.
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Timing of the dose matters
ICG for perfusion is given seconds before the check; for cholangiography 30–60 minutes before; 5-ALA three hours before knife-to-skin. Wrong timing means poor signal.
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It is an aid, not a replacement
Fluorescence guides the surgeon - it does not replace anatomy, palpation, frozen section or histology. Read every claim in that light.
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Evidence maturity varies
Bowel perfusion, sentinel node and cholangiography have strong evidence. Some tumour-targeted probes are still trial-stage - we tell you which is which.
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Red flags
A rash, breathing difficulty or drop in blood pressure after ICG is anaphylaxis - the anaesthetist treats it immediately. Photosensitive skin reaction after 5-ALA warrants urgent review.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever agent and platform were used, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Operation and agent used
The operation performed, the fluorescence agent (ICG, 5-ALA, pafolacianine) and the dose or timing.
- 02 Technique
Platform and NIR imaging steps
Robotic Firefly, laparoscopic or open - and at which steps the surgeon switched into near-infrared mode.
- 03 Findings
What the fluorescence showed
Perfusion of the anastomosis, the sentinel nodes retrieved, biliary anatomy, ureter course, or residual tumour lit up on the field.
- 04 Impression
Impact on the operation and next steps
Read this first: whether the dye changed the resection or the join, plus histology plans and follow-up.
Recognised by major UK insurers
Cover for the underlying operation is usually approved through the standard oncology or surgical pathway. The fluorescence add-on is often absorbed by the hospital, sometimes billed separately.
Frequently asked
Everything we get asked about fluorescence-guided surgery.
Quick answers on evidence, safety, dosing and how to access it privately in the UK.
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What is fluorescence-guided surgery?
It is surgery where a fluorescent dye - most commonly indocyanine green (ICG) or 5-aminolevulinic acid (5-ALA) - is given before or during the operation, and a near-infrared camera lets the surgeon see blood flow, lymph nodes, bile ducts, ureters or tumour tissue that would otherwise be invisible.
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When does fluorescence guidance actually change an operation?
The strongest evidence is in bowel-anastomosis perfusion (fewer leaks), sentinel-node mapping in breast, endometrial, cervical and gastric cancer, cholangiography during gallbladder surgery, and 5-ALA in high-grade glioma resection where the ALA-Glioma trial showed higher rates of complete tumour removal.
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Is ICG safe if I am allergic to iodine or shellfish?
Yes. The old iodine or shellfish warning is a myth - ICG does not contain iodine in a bioavailable form. True ICG anaphylaxis is very rare (under 1 in 40,000 doses) but the anaesthetic team is prepared for it.
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How much does fluorescence guidance add to the cost of a private operation in the UK?
For ICG, roughly £150–£800 depending on how it is used. 5-ALA (Gliolan) for glioma adds £1,800–£3,500. Tumour-targeted agents like pafolacianine (Cytalux) run £4,500–£7,500.
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What is 5-ALA and how is it used?
It is an oral drug (20 mg/kg) taken three hours before a craniotomy for suspected high-grade glioma. The tumour cells metabolise it into a fluorescent porphyrin that glows pink under blue-violet light, helping the neurosurgeon see the tumour edge.
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Do I need to avoid sunlight after 5-ALA?
Yes - for 24 hours after the dose. The ward keeps the lights low. Bright sunlight or strong theatre lights on exposed skin can cause a burn-like reaction while the drug is still active.
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Which hospitals in the UK offer this?
All major UK cancer centres and most large private hospitals have near-infrared platforms - robotic Firefly on the da Vinci Xi, Karl Storz or Stryker laparoscopic towers, and open handheld cameras. 5-ALA prescribing is more concentrated in tertiary neuro-oncology centres.
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Is it covered by NICE and NHS?
NICE has issued Interventional Procedure Guidance for individual uses (5-ALA for glioma, ICG for cholangiography, sentinel-node mapping in several cancers). Evidence maturity varies by indication - we tell you where your case sits.
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Will fluorescence find every tumour cell?
No. Near-infrared light only travels a few millimetres, and no dye lights up every tumour type. It is an aid to the surgeon, not a replacement for anatomy, frozen section or histology.
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When should I seek urgent advice after surgery?
A rash, breathing difficulty or drop in blood pressure during or shortly after ICG is anaphylaxis - the anaesthetist manages it immediately. A photosensitive skin reaction after 5-ALA warrants urgent review at the treating hospital.
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