The Evolution of Fluorescence-Guided Surgery

Abstract

There has been continual development of fluorescent agents, imaging systems, and their applications over the past several decades. With the recent FDA approvals of 5-aminolevulinic acid, hexaminolevulinate, and pafolacianine, much of the potential that fluorescence offers for image-guided oncologic surgery is now being actualized. In this article, we review the evolution of fluorescence-guided surgery, highlight the milestones which have contributed to successful clinical translation, and examine the future of targeted fluorescence imaging.

An ambient light-compatible, fluorescence-guided surgery imaging platform for real-time clinical assessment of vascular perfusion and flap viability in breast reconstruction

“…The need for reliable, objective quantitation and robust intraoperative surgical visualization of low-dose targeted fluorescent agents is critical to additional clinical applications such as oncologic surgery [1]. Thus, multiple professional societies have created task, working, and interest groups to develop guidelines, standards, and surveys regarding advancing the field.…”

“…Fluorescence imaging as an adjunct enhances the sensitivity, specificity, and reproducibility of surgical site assessment by highlighting tissue anatomy or function, which may be indistinct to standard-of-care visual cues, which include skin color, capillary refill, and tactile palpation. As a result, the utilization of FGS in the operating room (OR) has grown exponentially [1]. Real-time fluorescence imaging during surgery with the FDA-approved near-infrared dye indocyanine green (ICG) has been shown to significantly reduce the risk of major postoperative complications and overall loss of reconstruction by enabling assessment of tissue perfusion intraoperatively with immediate anastomotic revision if needed [2].…”

Fluorescent nano- and microparticles for sensing cellular microenvironment: past, present and future applications

“…243 In fact, intraoperative FL-guided surgery can today discriminate a healthy tissue from a cancerous one, resulting in more accurate resection of the diseased area. [244][245][246][247] The main advantage coming from such ne surgical resection is the complete eradication of the tumor. Therefore, this procedure is strictly linked to the reduction of tumor metastasis circulation from a primary lesion to other organs.…”

Evaluation of the Effect of Photodynamic Therapy on CAM-Grown Sarcomas

“…Photodynamic diagnosis (PDD) has become a valuable fluorescence-based tool in various medical disciplines, including surgical oncology [ 15 , 16 ]. For example, PDD with 5-aminolevulinc acid (5-ALA) increased the resection rate of gliomas from 40% to 80%, and the total-removal rate of glioblastomas by resection surgery improved from 36% to 66% [ 17 ].…”