Fluorescence in robotic surgery

Abstract

Currently, there are several clinical applications for intraoperative ICG, such as identification of vascular and biliary anatomy, assessment of organ and tissue perfusion, lymph node mapping, and real-time identification of lesions. In this paper we present a review of the available literature related to the use of ICG fluorescence in robotic surgery in order to provide a better understanding of the current applications, show the rapid growth of this technique, and demonstrate the potential future applications.

Robotic liver surgery: technical aspects and review of the literature

“…It could help to decrease intraoperative complications, especially in the presence of anatomical variations. In our practice, ICG fluorescence is used in all hepatobiliary procedures (31,32). Moreover, this technique has interesting perspectives for differentiation of hepatic lesions based on their vascular pattern.…”

Advances in fluorescent-image guided surgery

“…Iodine is rapidly excreted by the body and has a low penetrative ability (3,96). This means that to achieve sufficient contrast it must be administered very close to the time of surgery or the dose must be increased (36).…”

“…This means that to achieve sufficient contrast it must be administered very close to the time of surgery or the dose must be increased (36). The presence of inflammation, fibrosis, or excess fat also makes visualizing ICG more difficult (96,138). Another limitation to the implementation of these fluorescent probes is their contraindications.…”

“…Robotic surgeries are ideal for several procedures because they are precise, minimally invasive, and capable of reducing blood loss and shortening postoperative stay (96). Fluorescence has been used intraoperatively in these surgeries to visualize vascular and lymphatic anatomy, evaluate tissue perfusion, map biliary anatomy, identify lesions, and image metabolic activity (96)(97)(98)(99)(100)(101)(102)(103). Combining the minimally-invasive approach of robotic surgery with the accuracy and precision of fluorescence has the potential to improve safety and outcomes in a wide range of treatments, with several studies already highlighting the benefits.…”

A review on robotic surgery in rectal cancer

“…The integration of this equipment, which utilises near-infrared technology, provides real-time, image-guided identification of key anatomical landmarks. This assists in better oncological resection, i.e., identification and preservation of anatomical structures, lymph node dissection, differentiating malignancy from normal tissue, and assessing organ and tissue perfusion (44,45). Numerous research and technology groups are working towards transforming the robotic system that we use today.…”