Fluorescence-guided surgery: comprehensive review

Abstract

Background Despite significant improvements in preoperative workup and surgical planning, surgeons often rely on their eyes and hands during surgery. Although this can be sufficient in some patients, intraoperative guidance is highly desirable. Near-infrared fluorescence has been advocated as a potential technique to guide surgeons during surgery. Methods A literature search was conducted to identify relevant articles for fluorescence-guided surgery. The literature search was performed using Medical Subject Headings on PubMed for articles in English until November 2022 and a narrative review undertaken. Results The use of invisible light, enabling real-time imaging, superior penetration depth, and the possibility to use targeted imaging agents, makes this optical imaging technique increasingly popular. Four main indications are described in this review: tissue perfusion, lymph node assessment, anatomy of vital structures, and tumour tissue imaging. Furthermore, this review provides an overview of future opportunities in the field of fluorescence-guided surgery. Conclusion Fluorescence-guided surgery has proven to be a widely innovative technique applicable in many fields of surgery. The potential indications for its use are diverse and can be combined. The big challenge for the future will be in bringing experimental fluorophores and conjugates through trials and into clinical practice, as well as validation of computer visualization with large data sets. This will require collaborative surgical groups focusing on utility, efficacy, and outcomes for these techniques.

European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities

“…Indocyanine Green (ICG) imaging is another example of a promising new technique in emergency general surgery (EGS). Although it is not a novel technology, having received FDA approval in 1959, its current wide availability in our operating rooms and demonstrated safety, expanded its use [ 92 ]. In the emergency setting, fluorescence-guided surgery may improve duct visualization during laparoscopic cholecystectomy [ 93 ].…”

Optimizing Indocyanine Green Dosage for Near-Infrared Fluorescence Perfusion Assessment in Bowel Anastomosis: A Prospective, Systematic Dose-Ranging Study

“…The dosages recommended in this study can thus solely be applied to perfusion evaluation. Currently, there are no standardized application methods for ICG usage in the different clinical contexts, although most studies are using dosages in a range similar to the range used for perfusion assessment [1,2]. Moreover, a widespread heterogeneity can be observed in the literature regarding the timepoint and localization of ICG application [1,23].…”

“…One of the most promising recently developed techniques is indocyanine green (ICG) near-infrared fluorescence (NIRF), which is currently increasingly being applied across all surgical fields [1][2][3][4]. ICG-NIRF has gained recognition as a reliable real-time technique for visualizing tissue perfusion, e.g., enabling the precise placement of anastomoses and Life 2024, 14, 186 2 of 18 the identification of potential vascular compromise, potentially reducing perfusion-related complications [5,6].…”

Comparison of the In Vitro and In Vivo Behavior of a Series of NIR-II-Emitting Aza-BODIPYs Containing Different Water-Solubilizing Groups and Their Trastuzumab Antibody Conjugates

“…Today, there is no doubt that fluorescence is one of the most popular imaging techniques, from in vitro to clinical investigations and, in particular, for fluorescence-guided surgery (FGS). , The expansion of diverse optical imaging applications has been correlated with a significant growth in the development of fluorescent probes, with a particular emphasis on organic fluorophores . Among these fluorophores, cyanines have revolutionized the world of optical imaging thanks to their brightness, making them the fluorophores of choice today, particularly for in vivo and clinical applications.…”