Abstract
The introduction in surgical practice of NIR fluorescent systems with their augmented reality enhanced the visual abilities of the surgeons who imagined over just a decade a myriad of uses for this emergent technology. We reviewed the clinical applications of Indocyanine Green from intraoperative cholangiography and SLN identification to bowel perfusion assessment, endocrine surgery and evaluation of Crohn’s disease and Barrett’s esophagus. The immense value of this new method of functional and anatomical assessment is unequivocal, but there are pitfalls and drawbacks of the commercially available systems. By presenting all these we hope to disseminate the importance and the potential of the technology and to promote the interest in usage and research in the field.
Highlights
Emerging technologies such Near Infrared Fluorescence Imaging Systems are becoming a major contributor to increased performance in the operating theatre and help rethinking safety paradigms [1]
According to Kahramangil in his most recent review paper from 2017 about the use of near infrared fluorescence imaging in endocrine surgery finding the exact dissection plan is crucial for endocrine operations
The introduction of the NIR fluorescent systems with their augmented reality enhanced the visual abilities of the surgeons who became more accurate and able to treat old conditions in a new way
Summary
Emerging technologies such Near Infrared Fluorescence Imaging Systems are becoming a major contributor to increased performance in the operating theatre and help rethinking safety paradigms [1]. The technology uses a fluorescent dye emitting NIR light (which is capable of tissue penetration up to 1 cm) [4] and overlaps conventional imaging with digitalized data from the NIR spectrum in order to achieve augmented reality images during surgery [5]. In upper GI surgery this technology offers additional information on the biliary anastomoses, pancreatic stumps, functional information about the liver, details on its segmentation, intraoperative cholangyography and tumour localization. We first discuss the properties of the ICG and the NIR system followed by a more detailed presentation of the most important clinical applications summarizing at the end the pitfalls and challenges posed by this revolutionary technology which laid dormant for three quarters of a century only to emerge rapidly over the past 8-10 years after it has been linked to the progress in the engineering domains [7-35]
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