Possibilities Of Fluorescence Imaging In Laparoscopic Surgery

Abstract

Fluorescent imaging is increasingly being used to assist surgeons in making intraoperative decisions, which requires the use of fluorescent dyes that accumulate in anatomical or pathological structures, and their radiation is recorded by a laparoscope, with the function of detecting fluorescence. This review focuses on the use of fluorescent imaging in gastrointestinal surgery. The advantage of using fluorescent dyes is that they are highly selective for the target of interest. When using the indocyanine green, the intensity of the fluorescence signal detected in the tissue can be used as a marker of tissue perfusion, to assess the state of intestinal perfusion, intestinal anastomoses, anastomotic leaks, and the presence of affected lymph nodes. According to our data, the introduction of ICG into the mucosa around the tumor at the beginning of the operation makes it possible to clearly define the boundaries of the tumor lesion, which excludes the intersection of the intestine near the tumor. In addition, it is possible to visualize all the lymph nodes and lymphatic vessels through which the outflow of lymph from the tumor occurs. This makes it possible to determine the primary "sentinel" lymph node, the defeat of which requires an extended lymph node dissection, and in patients in whom the "sentinel" lymph node is not affected, you can limit yourself to a smaller volume of surgery. There is now increasing evidence that the use of fluorescence imaging during laparoscopic surgery can help the surgeon make intraoperative decisions in a wide range of situations, especially in assessing tissue perfusion, tumor pathology, lymphatic drainage, and identification of the urinary tract.