Fluorescence image-guided surgery

Fluorescence Image-Guided Surgery (FIGS) is a surgical technique that enhances the surgeon's ability to visualize and distinguish between tissues during surgery. This technique employs fluorescent dyes or agents that are administered to the patient either before or during the operation. When exposed to specific wavelengths of light, these agents emit fluorescence, allowing the surgeon to see the tissues in real time with enhanced contrast. FIGS is particularly useful in oncologic surgery for identifying tumor margins, in vascular surgery for visualizing blood flow, and in lymphatic surgery for mapping lymph nodes and vessels.

Overview

Fluorescence image-guided surgery combines the principles of fluorescence with medical imaging technologies to provide real-time visualization of anatomical structures and physiological functions during surgical procedures. The technique involves the use of fluorescent dyes that are selectively absorbed by certain tissues or cells. When illuminated with light of a specific wavelength, these dyes emit light at a different wavelength (fluorescence), which can be captured by specialized imaging systems.

Applications

Oncologic Surgery

In oncologic surgery, FIGS is used to delineate tumor margins more clearly, helping surgeons to remove tumors more precisely while sparing healthy tissue. This is crucial in achieving complete resection of malignant tissues, which is a key factor in reducing the risk of cancer recurrence. Fluorescent dyes such as indocyanine green (ICG) are often used for this purpose.

Vascular Surgery

FIGS plays a significant role in vascular surgery, where it aids in the visualization of blood vessels, helping surgeons to assess blood flow and identify vascular structures that need to be repaired or bypassed.

Lymphatic Surgery

In lymphatic surgery, FIGS is utilized to map lymph nodes and lymphatic vessels. This is particularly important in surgeries for lymphedema or for sentinel lymph node biopsy in cancer surgery, where it is crucial to accurately identify and assess lymphatic structures.

Techniques

The process of fluorescence image-guided surgery involves several steps: 1. Administration of a fluorescent dye to the patient. 2. Illumination of the surgical field with light of a specific wavelength to excite the fluorescent dye. 3. Capture of the emitted fluorescence with a specialized imaging system. 4. Real-time display of the fluorescence image to the surgeon, often overlaid on a standard visual image of the surgical field.

Advantages

The main advantages of FIGS include improved surgical precision, reduced operative time, and potentially better patient outcomes. By providing enhanced visualization of tissues, FIGS helps surgeons to perform more accurate and less invasive procedures.

Challenges

Despite its benefits, FIGS faces several challenges, including the need for specialized equipment, the potential for allergic reactions to fluorescent dyes, and the requirement for training in the interpretation of fluorescence images.

Future Directions

Research in fluorescence image-guided surgery is focused on developing new fluorescent agents that target specific tissues or disease processes, improving imaging technologies, and expanding the applications of FIGS to other areas of surgery.