Surgeons can safely enucleate multiple insulinomas near the main pancreatic duct using a novel approach that combines indocyanine green (ICG) fluorescence imaging with intraoperative ultrasound (IOUS).

• A 12.5 mg ICG bolus delivered intraoperatively allowed rapid tumor enhancement within 15 seconds and clear demarcation at 30 minutes.
• The procedure resulted in minimal blood loss (50 mL) and a 200-minute operative time, with no postoperative complications.

Preoperative ICG dosing is ineffective; use intraoperative bolus for best results.