Evaluating the Development Status of Fluorescence-Guided Surgery (FGS) in Pediatric Surgery Using the Idea, Development, Exploration, Assessment, and Long-Term Study (IDEAL) Framework

Abstract

Fluorescence-guided surgery (FGS) is used in many pediatric subspecialties but there are currently no standard guidelines or outcome data. We aimed to assess the current status of FGS in pediatrics using the Idea, Development, Exploration, Assessment, and Long-term study (IDEAL) framework. Clinical papers on FGS in children published from January 2000 to December 2022 were systematically reviewed. The stage of research development was measured considering seven fields of application: biliary tree imaging, vascular perfusion for gastrointestinal procedures, lymphatic flow imaging, tumor resection, urogenital surgery, plastic surgery, and miscellaneous procedures. Fifty-nine articles were selected. For each field of application, the overall IDEAL stage was determined to be 2a for biliary tree imaging (10 publications, 102 cases), 1 for vascular perfusion for gastrointestinal procedures (8 publications, 28 cases), 1 for lymphatic flow imaging (12 publications, 33 cases), 2a for tumor resection (20 publications, 238 cases), 2a for urogenital surgery (9 publications, 197 cases), and 1-2a for plastic surgery (4 publications, 26 cases). One report did not belong to any categories. FGS in children is still in an early phase of adoption and development. We recommend using the IDEAL framework as a guide and suggest developing multicenter studies to define the standard guidelines, effectiveness, and outcomes.

Monoclonal Antibodies for Targeted Fluorescence-Guided Surgery: A Review of Applicability across Multiple Solid Tumors

“…FGS is an emerging imaging tool that permits surgeons to identify healthy and pathological tissues, in real time, by intravenously delivering non-specific fluorophores (e.g., indocyanine green (ICG), 5-aminolevulinic acid, or fluorescein sodium) or fluorescently labeled molecules with a particular tissue or tumor tropism (e.g., mAbs). Depending on their route of administration, systemically administered non-specific fluorescent dyes can be used to help surgeons identify blood, bile, and lymphatic vessels during surgery, bridging the gap existing between preoperative anatomical imaging and patient-specific surgical findings [ 11 , 12 ].…”

Outcomes of nonrejection in weakly fluorescent intestine detected by indocyanine green fluorescence angiography: a case series of infants

“…To avoid massive bowel reduction for irrational reasons, leaving an ischemic bowel results in anatomical leakage and bowel stricture. Recently, indocyanine green fluorescence angiography (ICG-FA), a validated noninvasive imaging technique, has been used to evaluate tissue vascularization and guide intraoperative decisions in many surgical fields, including plastic surgery, neurosurgery, and general surgery [ 2 , 3 ]. ICG, a fluorescent agent, is a water-soluble dye with peak spectral absorption and emission at 800–810 nm in the blood or plasma.…”

Indocyanine Green (ICG) Fluorescence-Assisted Open Surgery Using the Rubina® Lens System in the Pediatric Population: A Single-Center Prospective Case Series

“…Over the last few years, ICG fluorescence technology has become a valid support to pediatric surgeons in different indications in both open and minimally invasive surgery (MIS) [1][2][3]. This technology is nowadays largely used to improve surgical decision making intraoperatively, detect hidden masses and have an accurate visualization of the anatomic structures.…”

“…This technology is nowadays largely used to improve surgical decision making intraoperatively, detect hidden masses and have an accurate visualization of the anatomic structures. Other advantages are present for visualization of tissue perfusion, vascularization and lymphatic flow [3]. Its use in pediatric MIS has been widely described in both laparoscopy and robotics [4][5][6][7][8].…”