Published: 12:03 AM, 22 August 2026
A New Light in Bangladesh’s Operating Rooms
Fahima Hossain Muna
Surgeons in Bangladesh are beginning to embrace a technology that allows them to see what the naked eye cannot. Fluorescence-guided surgery, powered most commonly by the dye indocyanine green (ICG), is offering surgeons a real-time view of blood vessels, bile ducts, tumors and lymph nodes during operations.
The technique involves injecting ICG into a patient's bloodstream before or during surgery. When exposed to near-infrared light, the dye fluoresces, making specific tissues and anatomical structures visible on a monitor in real time.
ICG itself is not new. The water-soluble compound binds to albumin, circulates rapidly through the bloodstream and is eventually cleared by the liver into bile. This makes it particularly useful for visualizing the biliary system. What has changed dramatically is the imaging technology built around the dye, allowing surgeons to observe these structures as they light up during an operation (Sutton et al., 2023).
Today, fluorescence guidance is being used for several purposes, including assessing tissue blood flow, mapping lymph nodes, identifying critical anatomy and locating tumors. It is a technology with growing evidence. The clinical evidence supporting fluorescence-guided surgery is also expanding.
A Swedish hospital study found that using ICG fluorescence during gallbladder removal, alongside a technique in which dissection proceeds from the top of the gallbladder downward, improved surgical safety. The findings build on earlier research suggesting that ICG guidance can reduce operating time and lower the likelihood of converting laparoscopic surgery into open surgery (Haverinen et al., 2025).
Similar benefits have been reported in cancer surgery. A study involving patients with gastric cancer found that marking tumors with ICG before laparoscopic gastrectomy resulted in a higher number of lymph nodes being retrieved, reduced noncompliance and shortened operating time compared with surgery without fluorescence guidance (Yang et al., 2025).
Early evidence from Bangladesh is also encouraging. Dr Anharur Rahman, a general and laparoscopic surgeon in Bangladesh, has reported similar findings in his clinical research. In an observational study involving 40 patients undergoing laparoscopic gallbladder surgery, he found that ICG fluorescence improved real-time visualization and surgical precision by clearly identifying the bile duct—one of the structures surgeons are particularly concerned about injuring during the procedure.
For Bangladesh, where operating rooms often handle large numbers of patients under significant time and resource constraints, the potential benefits are considerable: fewer complications, more precise surgery, shorter operating times and potentially fewer repeat procedures.
Yet fluorescence-guided surgery is not a magic solution. One of the biggest challenges is moving fluorescent technologies from research laboratories into routine clinical practice. New dyes require extensive validation, while computer-assisted image analysis must be tested against large and diverse patient datasets before it can be relied upon widely.
Cost is another major obstacle for Bangladesh. Fluorescence imaging systems and the associated dyes are significantly more expensive than many conventional surgical tools. Surgeons also require specialised training to interpret fluorescence signals correctly and integrate them with their clinical judgment.
There are clinical limitations as well. Because ICG is cleared through the liver, its usefulness can be reduced in patients with impaired liver function. Fluorescence may also be more difficult to detect through thicker layers of body fat. Although allergic reactions to ICG are uncommon, they have been documented.
Most importantly, fluorescence does not replace the surgeon's judgment. It provides an additional layer of visual information—it does not make clinical decisions on behalf of the surgeon.
Will Bangladesh see wider adoption? For now, fluorescence-guided surgery is likely to remain concentrated in larger private hospitals and specialised medical centres that can afford the initial investment in equipment, training and maintenance.
The science, however, is no longer merely experimental. International research increasingly supports its value in improving anatomical visualization, surgical precision and patient safety. Bangladesh's own emerging clinical experience adds another important dimension to that evidence.
The bigger question is therefore not whether the technology works, but who will have access to it. Wider adoption will depend on the cost of equipment and dyes, the availability of trained surgeons, institutional investment and, critically, whether public hospitals can gain access to the technology.
Dr Rahman's early experience suggests that fluorescence-guided surgery can translate effectively into the Bangladeshi clinical setting. The next challenge is ensuring that this promising technology does not remain confined to a handful of well-equipped hospitals but gradually becomes accessible to the patients and surgeons who could benefit from it most.
In Bangladesh's operating rooms, a new set of eyes is beginning to emerge. Whether those eyes can be made available across the country's healthcare system will ultimately depend not on the technology alone but on investment, training and equitable access.
Fahima Hossain Muna is a public health researcher.
