Fluorescence Image-Guided Robotic Surgery

Abstract

Fluorescence image-guided surgery (FIGS) is a surgical modality that employs the fluorescence optical detection and tracking system to identify fluorescence-labeled tissue structures in real time to guide a surgical procedure. Near-infrared fluorescence (NIRF) imaging with fluorophore indocyanine green (ICG) has been integrated into the robotic surgery platform, allowing FIGS to be used in robot-assisted minimally invasive procedures. Fluorescence image-guided robotic surgery is in its infancy. In urology, this technology has been tested in robotic partial nephrectomy for tumor margin identification and super-selective arterial clamping and in urinary tract reconstructions for tissue perfusion assessment, as well as in prostatectomy for sentinel lymph node mapping. Early experiences with this technology have demonstrated that ICG-NIRF image-guided robotic surgeries are feasible and safe and have the potential to improve the qualities and outcomes for certain major urologic procedures. Convincing data demonstrating the effectiveness in terms of improving the quality and outcome of surgery with reasonable costs or with decreased costs of overall care are still needed. The key advancement in fluorescence image-guided robotic surgery will rely on future engineering of robotic surgery imaging systems and developing tissue- or cell-type-specific fluorescence labeling contrasts suitable for clinical use.