A narrative review of fluorescence imaging in robotic-assisted surgery

Abstract

Objective: In this review, we provide examples of applications of fluorescence imaging in urologic, gynecologic, general, and endocrine surgeries. Background: While robotic-assisted surgery has helped increase the availability of minimally invasive procedures across surgical specialties, there remains an opportunity to reduce adverse events associated with open, laparoscopic, and robotic-assisted methods. In 2011, fluorescence imaging was introduced as an option to the da Vinci Surgical System, and has been standard equipment since 2014. Without interfering with surgical workflow, this fluorescence technology named Firefly ® allows for acquisition and display of near-infrared fluorescent signals that are co-registered with white light endoscopic images. As a result, robotic surgeons of all specialties have been able to explore the clinical utility of fluorescence guided surgery. Methods: Literature searches were performed using the PubMed and MEDLINE databases using the keywords “robotic-assisted fluorescence surgery”, “ICG robotic surgery”, and “fluorescence guided surgery” covering the years 2011–2020. Conclusions: Real-time intraoperative fluorescence guidance has shown great potential in helping guide surgeons in both simple and complex surgical interventions. Indocyanine green is one of the most widely-used imaging agents in fluorescence guided surgery, and other targeted, near-infrared imaging agents are in various stages of development. Fluorescence is becoming a reliable tool that can help surgeons in their decision-making process in some specialties, while explorations continue in others.

Morphological Characteristics, Hemoglobin Content, and Membrane Mechanical Properties of Red Blood Cell Delivery Systems

“…We have chosen ICG since it is an FDA-approved chromophore with a long-standing history in clinical applications and clinical research related to optical imaging and laser-based therapeutics. 16,17 ICG has also been encapsulated into RBC-based delivery systems for optical imaging and light-based theranostics. 18,19 We present results that demonstrate that the surface area, volume, and deformability of RBC ghosts ICG are significantly reduced as compared to RBCs.…”

“…We refer to these materials as RBC ghosts ICG since in a similar fashion to the common methodologies used in the fabrication of RBC-based delivery systems containing other cargos, − the construction process is based on the formation of hemoglobin-depleted RBC ghosts as an intermediate structure, which, in this case, becomes loaded with ICG. We have chosen ICG since it is an FDA-approved chromophore with a long-standing history in clinical applications and clinical research related to optical imaging and laser-based therapeutics. , ICG has also been encapsulated into RBC-based delivery systems for optical imaging and light-based theranostics. , …”

Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

“…Fluorescence-guided surgery was established in several different specialities. Indocyanine green (ICG) can be used to map lymph nodes in various cancers, detect tumour margins and evaluating bowel perfusion at anastomotic sites [ 94 ]. Three-dimensional modelling with a virtual reality viewing system is shown to augment the surgical planning process and result in improved patient outcomes.…”

Optical spectroscopy and imaging in surgical management of cancer patients

“…The impact of fluorescence imaging on intraoperative decision making in cancer surgery has recently been reviewed by Lauwerends et al [92]. Specific examples of ICG-based image guidance for which clinical outcome data are available are delineation of tumors and vital structures, including in robotic urologic surgery [93] and colorectal cancer ablation, and evaluation of anastomosis [94]. For example, a meta-analysis of 13 clinical trials of ICG fluorescence image guidance of liver cancer resection detected additional malignant hepatic tumors in 11.6% of patients [95].…”