Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 715 - файл

Indeed, recently, many innovations in surgical technique and minimally invasive technologies with laparoscopic, endoscopic, and robotic approaches have greatly improved surgical practice.

Nevertheless, despite these constant advances, surgery still relies primarily on the surgeon’s vision and on white-light reectance. The emerging eld of uorescent surgical imaging promises to be a powerful enhancement to improve surgical guidance.

Among all chromophores and uorophores that could work as probes in medical imaging techniques, near-infrared uorescence imaging with indocyanine green (ICG) is emerging as the major contribution to intraoperative surgical decisions, and many differ­ent applications have already been described in literature. ICG is a dye used in medicine since the mid-1950s for a variety of diag­nostic applications in cardiology and ophthalmology and to test the hepatic clearance. However, its uorescent properties have only recently been applied to new minimally invasive surgical instrumentations. ICG has some peculiar features that promote its widespread use, like low incidence of adverse effects and very high toxic dose for the human body.

Other uorescent probes already approved for clinical use are methylene blue (MB), uorescein sodium, and 5-aminolevulinic acid (5-ALA). Moreover, many probes are currently under clini­cal development.

In addition, uorescence-guided surgery appears to have a great potential to become a standard in everyday clinical practice due to its multiple different possible applications and its ease of employment.

on the physician’s hands and eyes. In 1895, Wilhelm Röntgen took the rst known X-ray picture of his wife’s hand, accidentally dis­covering the X-ray [2]. Since this report, after many decades of improvements in medicine, there are few imaging techniques rou­tinely employed in clinical practice that can be divided into two main segments: optical and radiological imaging [3].

Covering the 36% of the global market, radiological imaging includes X-ray, computed tomography (CT), ultrasound, magnetic resonance imaging (MRI), and positron emission tomography (PET), and only two of these (X-ray uoroscopy and ultrasound) are used occasionally for image-guided surgery. Indeed, these techniques are mainly used for preoperative imaging that is funda­mental to plan the surgery, but it can lead to misinterpretation dur­ing the procedure due to distortion of images and the time interval between imaging and surgery (e.g., in cancer patients) [4].

robotic technologies. Nevertheless, surgical practice is still based on anatomy as seen by the operating surgeon with white-light reectance. This approach does not allow an accurate differentia­tion between different tissues: in the body, they appear as various shades of white to pink (bone, nerves, cartilage, fat, connective tissue, and muscle) or red to deep red (blood vessels and more easily visible organs such as the liver, kidney, and spleen), thus leading to potential ambiguity during surgical dissection. Furthermore, open-eld surgery depends on the direct visualiza­tion of patient tissues, whereas in minimally invasive surgeries (i.e., microscopic, endoscopic, laparoscopic, and robotic surgery), patient’s tissues are visualized through an interface (viewed through the ocular eyepiece or using cameras and digital dis­plays). For the minimally invasive surgical procedures, the added hardware that is necessary for uorescence imaging can be tted into existing instrumentation. The emerging eld of uorescent surgical imaging promises to be a powerful enhancement to tradi­tional low-contrast white-light visualization, offering real-time highlighted delineation of complex anatomic structures. Improved visualization will lead to more complete removal of disease, decreased inadvertent injuries to vital structures, and improved identication for repair of damaged tissues [6].

In addition, working through an interface with cameras and instruments inserted into body cavities through narrow conduits has also sacriced tactile feedback of directly working with tissue and dissection along tissue planes. Thus, a medical specialty that is traditionally dependent on touch becomes even more dependent on vision. Thus, enhancing the visual differences between tissues by using uorescent probes based on structure or disease could be equated to color-coding the surgical eld. This is the reason why FGS could represent a major contribution to intraoperative decision- making during surgical procedures [7].

In 1819 and 1822, mineralogists Edward D.Clarke and René Just Haüy described uorescence in uorites, respectively. The phenomenon was described for chlorophyll by Sir David Brewster in 1833 and for quinine by Sir John Herschel in 1845.

In his 1852 article on “Refrangibility,” the British physicist and mathematician George Gabriel Stokes, noted for his studies of the behavior of viscous uids and for Stokes’ theorem, described the ability of uorspar and uranium glass to change invisible light beyond the violet end of the visible spectrum into blue light. This phenomenon was called “uorescence.” The name derives from the mineral uorite (calcium diuoride) that can contain traces of divalent europium that serves as the uorescent activator to emit blue light. In a fundamental experiment, a prism was used to iso­late ultraviolet radiation from sunlight and he observed blue light emitted by ethanol solution of quinine [8].

The rst clinical use of uorescence was in 1947, when it was used for identication of brain tumors during neurosurgery using the dye uorescein [9]. In 1953, Ray and Randall succeeded in detecting cancer cell in vaginal smears through a uorescent staining. The rationale behind the research was the afnity of the basic uorochrome dyes (berberine sulfate, acid fuchsin, and acri­dine) for nucleic acids. As neoplastic cells have an increase in total nucleic and ribonucleic acids, with an increase in protein synthesis, cancer cells were identied. A uorescent microscope was used to evidence this nding [10].