The employment of fluorescence imaging has gained popularity in many fields of adult surgery, such as organ perfusion assessment, intra-operative solid tumor identification and sentinel lymph node mapping. In this respect, it has demonstrated great potential to improve both surgical and oncological outcomes while minimizing anesthetic time and lowering health-care costs.However, the clinical application of Fluorescence-Guided Surgery (FGS) in pediatrics is just at the initial phase.Review of published literature indicates a paucity of clinical studies evaluating FGS in pediatric surgery but huge scope for preclinical investigation and new clinical studies. Great emphasis has been given to the clinical application of FGS for surgical resection of hepatoblastoma and its metastasis and for real-time imaging of the biliary tree. Other current uses of fluorescent imaging in children concern the assessment of blood perfusion and lymphatic flow with the aim to prevent iatrogenic injuries during intestinal and urogenital surgeries. While new and more specific probes are under development, the only fluorescent dyes safely employed in children are currently indocyanine green and fluorescein sodium. Advantages, limitations and potential future development of FGS in pediatrics are systematically discussed and analyzed.
What is already known• Thoracoscopy in neonates is known to be associated with intraoperative acidosis and hypercapnia.
What this article adds• Thoracoscopic repair of CDH or EA/TEF may result in more severe intraoperative acidosis and hypercapnia than during open surgery.
Conclusions.Neonates undergoing operative repair of CDH or EA/TEF develop intraoperative acidosis and hypercapnia, regardless of the approach used. However, this phenomenon is more severe during thoracoscopic repair. Novel modalities to reduce intraoperative gas derangements, particularly during thoracoscopic repair, need to be established.
Fluorescence guided surgery, augmented reality, and intra-operative imaging devices are rapidly pervading the field of surgical interventions, equipping the surgeon with powerful tools capable of enhancing the surgical visualisation of anatomical normal and pathological structures. There is a wide range of possibilities in the adult population to use these novel technologies and devices in the guidance for surgical procedures and minimally invasive surgeries. Their applications and their use have also been increasingly growing in the field of paediatric surgery, where the detailed visualisation of small anatomical structures could reduce procedure time, minimising surgical complications and ultimately improve the outcome of surgery. This review aims to illustrate the mechanisms underlying these innovations and their main applications in the clinical setting.
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