Near-infrared Fluorescence-guided Surgery Research Articles

Significance of Second Near-Infrared Region (NIR-II) guided tumour detection and surgical treatment using Carcinoembryonic Antigen-Related Cell Adhesion Molecule (CEACAM) targetted probe in colorectal surgery.

Respected Ma’am, According to WHO, cancer alone killed 10 million people in 2018., making it a leading cause of mortality worldwide (1). Near-infrared fluorescence-guided surgery, a rapidly evolving technique, enables surgeons to assess tumour borders of various cancer types and lesions of other prevalent illnesses with great precision. Near-Infrared Region (NIR) radiation's ability to absorb energy at one wavelength and remit it at a different, longer wavelength stimulates substances to fluorescence, aiding the complete surgical removal of tumour tissues with negative margins, thus, improving the disease’s prognosis and decreasing chances of reoccurrence (2). Conventional fluorescence-guided surgery focuses on the first near-infrared window (NIR-I, 700–900 nm), whose tissue penetration is limited to a depth of only 1-6 mm. In contrast, the second near-infrared window (NIR-II, 1000-1700 nm) significantly reduces tissue absorption, autofluorescence, and photon scattering, enabling a deep penetration (up to 20 mm), micron-scale resolution, and an increased tumor-to-normal tissue ratio (T/NT) leading to more precise tumour removal (1–3). A recent study in Beijing, China (3), has explored the value of the second near-infrared window (NIR-II, 1000-1700 nm) in image guided surgeries that uses 2D5-IRDye800CW, as a targeted NIR-II probe formed by the conjugation of 2D5-CEACAM5 nanobody (2D5)34 with IRDye800CW dye for intraoperative navigation in colorectal cancer which is the type of cancer known to have one of the highest mortality rates. To compare the efficacy of NIR-11 with that of NIR-1comparative studies were also conducted on mouse CA colon, orthotopic cancer and metastasis models. Compared to NIR-I, NIR-2 fluorescence had a much greater tumor to background ratio, the difference was statistically significant (p<0.0001) proving that the imaging probe was more sensitive in detecting tumours. This technique detected and resected tumours smaller than 2 mm, making it the most suitable option for cancer diagnosis and treatment (3). Henceforth, it can be deduced that 2D5-IRDye800CW and NIR-II fluorescence collectively have the potential to act as a way of improvement in surgery of colorectal cancer. Studies have also demonstrated the use of NIR-II systems for imaging the vasculature, detecting sentinel lymph nodes, image-guided cancer surgery, and fluorescence endoscopy (4). Its other good attributes include high precision during image-guided procedures, over currently used NIR-I radiations (3). Finally, NIR-II fluorescence technique's crucial role in detecting and treating tumours, highlights its importance and warrants further advancement.

Securing Resection Margin Using Indocyanine Green Diffusion Range on Gastric Wall during NIR Fluorescence-Guided Surgery in Early Gastric Cancer Patients.

Near-infrared (NIR) fluorescence lymphography-guided minimally invasive gastrectomy using indocyanine green (ICG) is employed to visualize draining lymphatic vessels and lymph nodes. Endoscopically injected ICG spreads along the gastric wall and emits fluorescence from the serosal surface of the stomach. We aimed to assess the efficacy of ICG diffusion in securing the resection margin. We retrospectively analyzed 503 patients with early gastric cancer located in the body of the stomach who underwent fluorescence lymphography-guided gastrectomy from 2018 to 2021. One day before surgery, ICG was endoscopically injected into four points of the submucosal layer peritumorally. We measured the extent of resection and the resection line based on the ICG diffusion area from the specimen using NIR imaging. The mean area of the ICG diffusion was 82.7 × 75.3 and 86.7 × 80.2 mm2 on the mucosal and serosal sides, respectively. After subtotal gastrectomy, the length of the proximal resection margin was 38.1 ± 20.1, 33.4 ± 22.2, and 28.7 ± 17.2 mm in gastroduodenostomy, loop gastrojejunostomy, and Roux-en-Y gastrojejunostomy, respectively. The ICG diffusion area along the gastric wall secured a resection margin of >28 mm. The ICG diffusion range can be used as a simple and easy method for determining the resection margin during gastrectomy using NIR imaging.

Near-infrared fluorescence guided surgery: State of the evidence from a health technology assessment perspective.

Different applications of near-infrared fluorescence-guided surgery are very promising, and techniques that help surgeons in intraoperative guidance have been developed, thereby bridging the gap between preoperative imaging and intraoperative visualization and palpation. Thus, these techniques are advantageous in terms of being faster, safer, less invasive, and cheaper. There are a few fluorescent dyes available, but the most commonly used dye is indocyanine green. It can be used in its natural form, but different nanocapsulated and targeted modifications are possible, making this dye more stable and specific. A new active tumor-targeting strategy is the conjugation of indocyanine green nanoparticles with antibodies, making this dye targeted and highly selective to various tumor proteins. In this mini-review, we discuss the application of near-infrared fluorescence-guided techniques in thoracic surgery. During lung surgery, it can help find small, non-palpable, or additional tumor nodules, it is also useful for finding the sentinel lymph node and identifying the proper intersegmental plane for segmentectomies. Furthermore, it can help visualize the thoracic duct, smaller bullae of the lung, phrenic nerve, or pleural nodules. We summarize current applications and provide a framework for future applications and development.

Experience With the 3D Orbeye Exoscope in Near-Infrared Fluorescence-Guided Surgery Using Indocyanine-Green and a Comparison Against a Dedicated Near-Infrared Imaging Platform

Experience With the 3D Orbeye Exoscope in Near-Infrared Fluorescence-Guided Surgery Using Indocyanine-Green and a Comparison Against a Dedicated Near-Infrared Imaging Platform

Near-infrared fluorescence-guided surgery using indocyanine green facilitates secure infrapyloric lymph node dissection during laparoscopic distal gastrectomy.

We aimed to investigate the usefulness of near-infrared indocyanine green (ICG)-enhanced fluorescence guidance for infrapyloric LN dissection in laparoscopic distal gastrectomy. This study enrolled patients with early gastric cancer scheduled for laparoscopic distal gastrectomy. After intraoperative submucosal injection of ICG (0.1mg/mL), LN dissection was conducted under near-infrared ICG fluorescence guidance. The operation time, bleeding events during infrapyloric LN dissection were analyzed. Cases were retrospectively 1:3 propensity-score matched to patients who underwent laparoscopic distal gastrectomy without ICG injection. The mean time from midline omentectomy to exposure of the right gastroepiploic vein was significantly shorter in the ICG group (n = 20) than in the non-ICG group (n = 60) (13.05 ± 5.77 vs 18.68 ± 7.92min; p = 0.001), and the incidence of bleeding during infrapyloric LN dissection was lower in the ICG group (20% vs 68.3%, p < 0.001). The two groups did not differ significantly regarding the number of LNs retrieved from the infrapyloric area (p = 0.434). Near-infrared ICG fluorescence guidance facilitates safe and fast infrapyloric LN dissection in laparoscopic distal gastrectomy.

Indocyanine-Green for Fluorescence-Guided Surgery of Brain Tumors: Evidence, Techniques, and Practical Experience.

The primary treatment for brain tumors often involves surgical resection for diagnosis, relief of mass effect, and prolonged survival. In neurosurgery, it is of utmost importance to achieve maximal safe resection while minimizing iatrogenic neurologic deficit. Thus, neurosurgeons often rely on extra tools in the operating room, such as neuronavigation, intraoperative magnetic resonance imaging, and/or intraoperative rapid pathology. However, these tools can be expensive, not readily available, time-consuming, and/or inaccurate. Recently, fluorescence-guided surgery has emerged as a cost-effective method to accurately visualize neoplastic areas in real-time to guide resection. Currently, 5-aminolevulinic-acid (5-ALA) remains the only fluorophore that has been approved specifically for fluorescence-guided tumor resection. Its use has demonstrated improved resection rates and prolonged progression-free survival. However, protoporphyrin-IX, the metabolic product of 5-ALA that accumulates in neoplastic cells, fluoresces in the visible-light range, which suffers from limited tissue penetration and significant auto-fluorescence. Near-infrared fluorescence, on the other hand, overcomes these problems with ease. Since 2012, researchers at our institution have developed a novel technique using indocyanine-green, which is a well-known near-infrared fluorophore used traditionally for angiography. This Second-Window-ICG (SWIG) technique takes advantage of the increased endothelial permeability in peritumoral tissue, which allows indocyanine-green to accumulate in these areas for intraoperative visualization of the tumor. SWIG has demonstrated utility in gliomas, meningiomas, metastases, pituitary adenomas, chordomas, and craniopharyngiomas. The main benefits of SWIG stem from its highly sensitive detection of neoplastic tissue in a wide variety of intracranial pathologies in real-time, which can help neurosurgeons both during surgical resections and in stereotactic biopsies. In this review of this novel technique, we summarize the development and mechanism of action of SWIG, provide evidence for its benefits, and discuss its limitations. Finally, for those interested in near-infrared fluorescence-guided surgery, we provide suggestions for maximizing the benefits while minimizing the limitations of SWIG based on our own experience thus far.

Introducing fluorescence guided surgery into orthopedic oncology: A systematic review of candidate protein targets for Ewing sarcoma

Ewing sarcoma (ES), an aggressive bone and soft‐tissue tumor, is treated with chemotherapy, radiotherapy, and surgery. Intra‐operative distinction between healthy and tumorous tissue is of paramount importance but challenging, especially after chemotherapy and at complex anatomical locations. Near infrared (NIR) fluorescence‐guided surgery (FGS) is able to facilitate the determination of tumor boundaries intra‐operatively, improving complete resection and therefore survival. This review evaluates potential ES‐specific proteins from the literature as targets for NIR FGS.

Method for Real-Time Tissue Quantification of Indocyanine Green Revealing Optimal Conditions for Near Infrared Fluorescence Guided Surgery.

Near infrared fluorescence guided surgery (NIRFGS) offers better distinction between cancerous and normal tissues compared to surgeries relying on a surgeon's senses of sight and touch. Because of the greater accuracy in determining tumor tissue margins, NIRFGS within clinics continues to grow. However, NIRFGS lacks standardization of the indocyanine green (ICG) dose and the preoperative period allowed after ICG administration. In an aim to find optimal doses and preoperative periods for NIRFGS standardization, we developed a method that quantitatively determines ICG levels within tissues in real-time. We find that not only do the dose and the preoperative periods influence tumor-to-background ratios (TBRs), but both also heavily influence subject-to-subject variances of these ratios. Optimal detection conditions are observed when larger than typical ICG doses are administered and longer than typical preoperative periods are allowed. Larger doses lead to increased TBRs, but longer preoperative periods are necessary to reduce TBR variances to those observed when using smaller doses. Our results suggest that a clinical investigation into maximum tolerable ICG doses and prolonging preoperative periods in NIRFGS is warranted.