Abstract
Nowadays, surgical innovations incorporate new technological conquests and must be validated by evidence-based medicine. The use of augmented reality-assisted indocyanine green (ICG) fluorescence has generated a myriad of intraoperative applications such as demonstration of key anatomical landmarks, sentinel lymph nodes, and real-time assessment of local blood flow. This paper presents a systematic review of the clinical evidence regarding the applications of ICG near-infrared (NIR) fluorescence in colorectal surgery. After we removed duplicate publications and screened for eligibility, a total of 36 articles were evaluated: 23 on perfusion assessment, 10 on lymph node mapping, and 3 on intraoperative identification of ureters. Lack of homogenous studies, low statistical power, and confounding evidence were found to be common amongst publications supporting the use of ICG in colorectal surgery, raising concerns over this seductive technique′s cost efficiency and redundancy. The compiled data showed that ICG NIR fluorescence may be a game-changer in particular situations, as proven for low colorectal anastomosis or lateral pelvic lymph node dissection, but it remains controversial for routine use and sentinel lymph node assessment. Further randomized studies are needed to confirm these conclusions. Future research directions include tumor-targeted fluorescence imaging and digital software for quantitative evaluation of fluorescence.
Highlights
Visionary ideas have almost never been embraced by the academic community without intense scrutiny concerning their scientific principles and favorable peer perception.Not long ago, the introduction of laparoscopy faced strong opposition and its promotor, Dr Eric Muhe was ridiculed with derogatory remarks
Our research identified 71 articles related to the use of indocyanine green (ICG) in vascular assessment of anastomoses, but only 23 papers remained eligible for review after a Preferred for for Reviews and Meta-Analyses (PRISMA) evaluation [13,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]
We demonstrated that ICG near-infrared fluorescence (NIR) fluorescence might not be recommended as a routine examination in colonic surgery, it has been proved to be useful in vascular assessment of anastomoses in left colic and rectal cancer surgery
Summary
Visionary ideas have almost never been embraced by the academic community without intense scrutiny concerning their scientific principles and favorable peer perception.Not long ago, the introduction of laparoscopy faced strong opposition and its promotor, Dr Eric Muhe was ridiculed with derogatory remarks. The molecule of ICG has a unique quantum profile, being able to emit endogenous fluorescence when a beam of near-infrared light is cast upon it. This method allows for the accurate identification of anatomical structures and real-time assessment of local blood flow. Enhancement of conventional human senses through augmented reality that can accurately locate anatomical structures and provide real-time functional information on tissues on the basis of ICG’s fluorescent properties is seductive but has the potential to be a game-changer in the surgical field. Like all newly developed technologies, near-infrared fluorescence (NIR)-assisted surgery must satisfy unmet clinical needs, be safe and cost-effective, and provide advantages over traditional approaches
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