Fluorescence-Guided Surgery and Novel Innovative Technologies for Improved Visualization in Pediatric Urology

Abstract

Fluorescence-guided surgery (FGS), three-dimensional (3D) imaging technologies, and other innovative devices are rapidly revolutionizing the field of urology, providing surgeons with powerful tools for a more complete understanding of patient-specific anatomy. Today, several new intraoperative imaging technologies and cutting-edge devices are available in adult urology to assist surgeons in delivering personalized interventions. Their applications are also gradually growing in general pediatric surgery, where the detailed visualization of normal and pathological structures has the potential to significantly minimize perioperative complications and improve surgical outcomes. In the field of pediatric urology, FGS, 3D reconstructions and printing technologies, augmented reality (AR) devices, contrast-enhanced ultrasound (CEUS), and intraoperative magnetic resonance imaging (iMRI) have been increasingly adopted for a more realistic understanding of the normal and abnormal anatomy, providing a valuable insight to deliver customized treatments in real time. This narrative review aims to illustrate the main applications of these new technologies and imaging devices in the clinical setting of pediatric urology by selecting, with a strict methodology, the most promising articles published in the international scientific literature on this topic. The purpose is to favor early adoption and stimulate more research on this topic for the benefit of children.

Rational Design and Biological Application of Hybrid Fluorophores

“…Hybrid fluorophores will exhibit increasingly superior photophysical properties in the foreseeable future and find wider applications, such as fluorescent-guided surgical therapy (FGS), which can help overcome issues like high background fluorescence. [151][152][153] Hybridization can not only change the photophysical properties of fluorophores, but also has the potential to be applied in other aspects, for example, water solubility of hybrid fluorophores can be improved by hybridization of poorly water-soluble fluorophores with good water-soluble fluorophores. [154] The exploration of other possibilities remains to be pursued.…”

“…Hybridization will not only involve the hybridization of two classical fluorophores but also the hybridization of three or more hybrid fluorophores, which will combine more advantages in the new hybrid fluorophores, thereby improving the photophysical properties of fluorophores. Hybrid fluorophores will exhibit increasingly superior photophysical properties in the foreseeable future and find wider applications, such as fluorescent‐guided surgical therapy (FGS), which can help overcome issues like high background fluorescence [151–153] . Hybridization can not only change the photophysical properties of fluorophores, but also has the potential to be applied in other aspects, for example, water solubility of hybrid fluorophores can be improved by hybridization of poorly water‐soluble fluorophores with good water‐soluble fluorophores [154] .…”

Preoperative three-dimensional modelling and virtual reality planning aids nephron sparing surgery in a child with bilateral Wilms tumour

“…Although CECT volume rendering remains the main imaging tool, VR, AR and 3D printing technologies supplement complex oncological cases where vascular and tumour anatomy need to be well defined 14. Fluorescence-guided surgery, by incorporating NIR (near infrared dyes) like indocyanine green (wavelength: 700–900 nm) intravenously one day before the surgery, helps the surgeon to delineate the tumour from normal tissue in real-time 33 34. It also helps to detect the course of the ureter, vasculature at the renal hilum and the presence of non-functioning moiety 35.…”

Nephron-sparing surgery for Wilms tumor

“…We have found threedimensional reconstruction particularly useful in facilitating the planning of NSS (Figure 7). Three dimensional reconstructions can be used to generate 3D printed models of the tumor and renal anatomy or the reconstructions can be viewed using virtual reality systems to enhance appreciation of tumor anatomy (28)(29)(30). Van der Zee et al have described a "virtual resection" in which real time manipulation of 3D reconstructions is utilized to plan NSS and to estimate the expected residual renal volume after resection (31).…”