Intraoperative near-infrared fluorescent imaging during robotic operations

Abstract

The intraoperative identification of certain anatomical structures because they are small or visually occult may be challenging. The development of minimally invasive surgery brought additional difficulties to identify these structures due to the lack of complete tactile sensitivity. A number of different forms of intraoperative mapping have been tried. Recently, the near-infrared fluorescence imaging technology with indocyanine green has been added to robotic platforms. In addition, this technology has been tested in several types of operations, and has advantages such as safety, low cost and good results. Disadvantages are linked to contrast distribution in certain clinical scenarios. The intraoperative near-infrared fluorescent imaging is new and promising addition to robotic surgery. Several reports show the utility of this technology in several different procedures. The ideal dose, time and site for dye injection are not well defined. No high quality evidence-based comparative studies and long-term follow-up outcomes have been published so far. Initial results, however, are good and safe.

Feasibility of indocyanine green fluorescence imaging for intraoperative identification of parathyroid glands during thyroid surgery

“…A promising technique to visualize healthy and diseased parathyroid tissue has emerged in the use of intraoperative NIRF imaging using intravenously administered indocyanine green (ICG). This safe and rapidly evolving intraoperative imaging modality is described for use in a wide range of surgical procedures, such as identification of the biliary anatomy, assessment of anastomotic perfusion, and sentinel lymph node mapping . Suh et al showed fluorescent PGs when using NIRF imaging with ICG in three dogs .…”

“…This safe and rapidly evolving intraoperative imaging modality is described for use in a wide range of surgical procedures, such as identification of the biliary anatomy, assessment of anastomotic perfusion, and sentinel lymph node mapping. [14][15][16] Suh et al showed fluorescent PGs when using NIRF imaging with ICG in three dogs. 17 Other studies showed the possibility of ICG fluorescent angiography to assess the remaining blood supply to the PGs in humans.…”

Robotic gastrectomy for gastric cancer: Current evidence

“…As proper lymphadenectomy is crucial for an adequate oncological operation for gastric cancer, near infrared imaging improves visualization of vascular anatomy and lymph node identification 47. This technology has been incorporated into multiple specialties as well preventing organ injuries such as to the ureter and biliary ducts 48. In the field of colorectal surgery, in addition to its use in primary surgery, near infrared imaging has been used as a guide for resection of liver metastasis as well as detection of peritoneal carcinomatosis 49.…”