Fluorescence-guided surgery: comprehensive review

• Published in: BJS open Vol. 7; no. 3
• Main Authors: Sutton, Paul A, van Dam, Martijn A, Cahill, Ronan A, Mieog, Sven, Polom, Karol, Vahrmeijer, Alexander L, van der Vorst, Joost
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 05.05.2023
• Subjects: Fluorescent Dyes; Humans; Optical Imaging - methods; Review; Surgery, Computer-Assisted - methods
• ISSN: 2474-9842; 2474-9842
• DOI: 10.1093/bjsopen/zrad049

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. As the pioneers in fluorescence-guided surgery paved the way for over 20 years, a new generation of surgeons is adapting this innovative technique in daily practice. It is remarkable that fluorescence-guided surgery has been adopted by not only general and abdominal surgeons, but by a wide variety of medical specialties. Four main indications are described in this manuscript: tissue perfusion, lymph node assessment, anatomy of vital structures, and tumour tissue imaging. Furthermore, we aim to give an overview of future opportunities in the field of fluorescence-guided surgery.