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L. Baldari et al.
Table1.3 reports some of the most widely adopted devices both for
conventional and minimally invasive/robotic surgery (Table1.3).
Table 1.3 Some of the most widely adopted NIR imaging systems both for
conventional and minimally invasive/robotic uorescence-guided surgery
Imaging
system
Stryker 1688
advanced
imaging
modalities
Pinpoint
with
SPY-PHI
Karl Storz
1 S™
Arthrex Synergy ID
Da Vinci
Surgical
System
(Intuitive)
Image 1S™ HD xenon
Image 1S™
Rubina™
System
Firey
camera
system
integrated
into Da Vinci
Si and Xi
Image
resolution Use
4k Laparoscopic – Green overlay
Full HD Open – Green overlay
Laparoscopic – Optical
light
source
4k and 3D Laparoscopic – Overlay mode
Laser-free
LED light
source
4k Laparoscopic – Overlay mode
3D Robotic – Normal imaging
LED light – No overlay
Visualization
mode
mode
– SPY-ENV mode
– SPY-contrast
– IRIS
mode
– Color-
segmented
uorescence
mode
– SPY-
uorescence
mode
illumination and
contrast-
enhanced
modality
– No overlay
mode
– Intensity map
– Monochromatic
– Monochromatic
and uorescent
modes
mode
1 History andScience ofImmunouorescence
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Conclusion
In conclusion, since its rst clinical application in surgery, uorescence underwent huge development and spread among specialties. Among all the uorophores, indocyanine green is the most
diffused, thanks to its peculiar features that promote its widespread. Many probes are currently under clinical development and
will be on the market soon.
A growing number of companies are developing systems for
uorescence-guided surgery. This imaging system is in constant
evolution with many features like overlay visualization and the
second near-infrared window (1000–1700 nm), enhancing the
power and increasing applications of this technology.
References
1. Gioux S, Choi HS, Frangioni JV.Image-guided surgery using invisible
near-infrared light: fundamentals of clinical translation. Mol Imaging.
2010;9(5):237–55.
2. Howell JD.Early clinical use of the x-ray. Trans Am Clin Climatol Assoc.
2016;127:341–9.
3. Pogue BW. Optics of medical imaging: optics plays dominant role in
medical imaging market. In: SPIE professional, 2018. p.6–8.
4. Stewart HL, Birch DJS. Fluorescence guided surgery. Methods Appl
Fluoresc. 2021;9:4.
5. National Research Council. Medical optical imaging mathematics and
physics of emerging biomedical imaging. Washington DC: National
Academy Press; 1996. https://doi.org/10.17226/5066.
6. Orosco RK, Tsien RY, Nguyen QT. Fluorescence imaging in surgery.
IEEE Rev Biomed Eng. 2013;6:178–87.
7. Nguyen QT, Tsien RY.Fluorescence-guided surgery with live molecular
navigation--a new cutting edge. Nat Rev Cancer 2013;13(9):
653–662.
8. Dip FD, Ishizawa T, Kodudo N, Rosenthal RJ.Fluorescence imaging for
surgeons concepts and applications. Basel: Springer; 2015. p. 3–23.
ISBN: 978-3-319-35213-8.
9. Moore GE.Fluorescein as an agent in the differentiation of normal and
malignant tissues. Science. 1947;106:130–1.
10. Lay CL, Randall LM.Fluorescent staining for detection of cancer cells in
vaginal smears. Surg Forum. 1953:321–7.
28
https://t.me/medicina_free
11. Raymond J, Lanzafame MD, David W, Rogers BS, John O, Nairn MS,
etal. Hematoporphyrin derivative uorescence: photographic techniques
for the localization of malignant tissue. Lasers Surg Med. 1986;6(3):328–
35.
12. Ahlquist RE Jr, Figge FH.Fluorescence of the extrahepatic biliary system
following parenteral hematoporphyrin administration. Surg Forum.
1956;6:356–8.
13. Ackermann NB, Mc Fee AS.Tetracycline uorescence in benign and
malignant tissues. Surgery. 1963;53:247–52.
14. Sandlow LJ, Allen HA.The use of tetracycline uorescence in the detection of gastric malignancy. Ann Intern Med. 1963;58(3):409–13.
15. Whitmore WF Jr, Bush IM.Ultraviolet cystoscopy in patients with bladder cancer. Trans Am Assoc Genitourin Surg. 1965;57:149–55.
16. Málek P, Kolc J, Pultr V, Zástava V.Tetracycline uorescence test in evaluation of ischemic changes in kidney transplantations. Rozhl Chir.
1966;45(4):252–6.
17. Cassini MF, da Costa MM.Fluorescence spectroscopy in renal ischemia
and reperfusion: noninvasive evaluation of organ viability. Transplant
Proc. 2013;45(5):1715–9.
18. Nessel E, Wiggermann W.The tetracycline uorescence test in surgery of
malignant tumors; rhinolaryngologic experiences. HNO.
1965;13(12):346–9.
19. Goldhahn WE. Fluorescence studies of brain tumors. Beitr Neurochir.
1966;13:126–9.
20. Khutsishili TS, Milaeva MA.The use of the uorescent method for determining the degree of revascularization of the heart in the surgical treatment of experimental cardiac ischemia. Grudn Khir. 1965;7(6):11–2.
Russian.
21. Loisance D, Sadony V.Value of uorescence in the macroscopic delimitation of experimental acute myocardial ischemia before and after revascularization. Arch Mal Coeur Vaiss 1973;66(6):701–707.
22. Zhang RR, Schroeder AB, Grudzinski JJ, Rosenthal EL, Warram JM,
Pinchuk AN, etal. Beyond the margins: real-time detection of cancer
using targeted uorophores. Nat Rev Clin Oncol. 2017;14(6):347–64.
23. Mordon S, Devoisselle JM, Soulie-Begu S, Desmettre T. Indocyanine
green: physicochemical factors affecting its uorescence in vivo.
Microvasc Res. 1998;55:146–52.
24. Desmettre T, Devoisselle JM, Mordon S. Fluorescence properties and
metabolic features of indocyanine green (ICG) as related to angiography.
Surv Ophthalmol. 2000;45:15–27.
25. Valeur B, Berberan-Santos MN.Molecular uorescence: principles and
applications. Weinheim: Wiley-VCH; 2012. ISBN: 978-3-527-32837-6.
26. Lakowicz JR.Principles of uorescence spectroscopy. New York, NY:
Springer; 2010. ISBN: 978-1-4615-7658-7.
L. Baldari et al.
1 History andScience ofImmunouorescence
https://t.me/medicina_free
27. Azzopardi EA, Owens SE, Murison M, Rees D, Anne Sawhney M,
Francis LW, et al. Chromophores in operative surgery: current practice
and rationalized development. J Control Release. 2017;249:123–30.
28. Rashid A, Warnakulasuriya S. The use of light-based (optical) detection
systems as adjuncts in the detection of oral cancer and oral potentially
malignant disorders: a systematic review. J Oral Pathol Med.
2015;44(5):307–28.
29. de Boer E, Harlaar NJ, Taruttis A, Nagengast WB, Rosenthal EL,
Ntziachristos V, van Dam GM.Optical innovations in surgery. Br J Surg.
2015;102(2):e56–72.
30. Fernandez-Suarez M, Ting AY. Fluorescent probes for super-resolution
imaging in living cells. Nat Rev Mol Cell Biol. 2008;9(12):929–43.
31. Mondal SB, et al. Real-time uorescence image-guided oncologic surgery. Adv Cancer Res. 2014;124:171–211.
32. Marmorstein AD, Marmorstein LY, Sakaguchi H, Hollyeld JG.Spectral
proling of autouorescence associated with lipofuscin, Bruch’s membrane, and sub-RPE deposits in normal and AMD eyes. Invest Ophthalmol
Vis Sci. 2002;43(7):2435–41.
33. Shin D, Vigneswaran N, Gillenwater A, Richards-Kortum R.Advances in
uorescence imaging techniques to detect oral cancer and its precursors.
Future Oncol. 2010;6:1143–54.
34. Selvam S, Sarkar I.Bile salt induced solubilization of methylene blue:
study on methylene blue uorescence properties and molecular mechanics calculation. J Pharm Anal. 2017;7:71–5.
35. Matsui A, Tanaka E, Choi HS, Kianzad V, Gioux S, Lomnes SJ, Frangioni
JV. Real-time, near-infrared, uorescence-guided identication of the
ureters using methylene blue. Surgery. 2010;148:78–86.
36. Alander JT, Kaartinen I, Laakso A, Pätilä T, Spillmann T, Tuchin VV,
etal. A review of indocyanine green uorescent imaging in surgery. Int J
Biomed Imaging. 2012;2012:940585.
37. Schaafsma BE, Mieog JS, Hutteman M, vad der Vorst JR, Kuppen PJ,
Lowik CW, etal. The clinical use of indocyanine green as a near-infrared
uorescent contrast agent for image-guided oncologic surgery. J Surg
Oncol. 2011;104:323–32.
38. Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen
HJ. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III
trial. Lancet Oncol. 2006;7(5):392–401.
39. Staderini M, Megia-Fernandez A, Dhaliwal K, Bradley M.Peptides for
optical medical imaging and steps towards therapy. Bioorg Med Chem.
2018;26:2816–26.
40. Hoogstins CES, Boogerd LSF, Sibinga Mulder BG, Mieog JSD,
Swijnenburg RJ, van de Velde CJH, et al. Image-guided surgery in
patients with pancreatic cancer: rst results of a clinical trial using SGM-
29
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https://t.me/medicina_free
101, a novel carcinoembryonic antigen-targeting, near-infrared uorescent agent. Ann Surg Oncol. 2018;25:3350–7.
41. Patil CG, Walker DG, Miller DM, Butte P, Morrison B, Kittle DS, etal.
Phase 1 safety, pharmacokinetics, and uorescence imaging study of
Tozuleristide (BLZ-100) in adults with newly diagnosed or recurrent
gliomas. Neurosurgery. 2019;85:E641–9.
42. Randall LM, Wenham RM, Low PS, Dowdy SC, Tanyi JL.A phase II,
multicenter, open-label trial of OTL38 injection for the intra-operative
imaging of folate receptor-alpha positive ovarian cancer. Gynecol Oncol.
2019;155:63–8.
43. Luo S, Zhang E, Su Y, Cheng T, Shi C.A review of NIR dyes in cancer
targeting and imaging. Biomaterials. 2011;32:7127–38.
44. Engelborghs Y, Visser AJWG. Fluorescence spectroscopy and microscopy: methods and protocols. Methods Mol Biol. 2014. https://doi.
org/10.1007/978- 1- 62703- 649- 8.
45. Sevick-Muraca EM, Houston JP, Gurnkel M.Fluorescence-enhanced,
nearinfrared diagnostic imaging with contrast agents. Curr Opin Chem
Biol. 2002;6:642–50.
L. Baldari et al.
Current Fluorescence- Guided
https://t.me/medicina_free
Platforms andDevices
DonovanHui, KevinCarroll,
ChristinaSanders, andDavidPechman
Introduction
Fluorescence-guided surgery (FGS) enables clinicians to visualize uorescence-enhanced images in real time to assist in surgical procedures. Its use has transformed the way surgeons
visualize structures that may not be apparent under visible light
alone [1]. The wavelength of visible light is between 380 and
780 nm. Near- infrared (NIR) extends from a wavelength of
780–2500 nm with penetration of tissues ranging from 5 to
D. Hui
Department of Surgery, New York Medical College Metropolitan
Hospital Center, New York, NY, USA
K. Carroll
Department of Surgery, Northwell Health—South Shore University
Hospital, Bay Shore, NY, USA
C. Sanders
Department of Surgery, Jacobs School of Medicine and Biomedical
Sciences, State University of NewYork at Buffalo, Buffalo, NY, USA
e-mail: cs328@buffalo.edu
D. Pechman (*)
Department of Surgery, Zucker School of Medicine at Hofstra,
Northwell Health—South Shore University Hospital,
Bay Shore, NY, USA
2
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
N. Szoka et al. (eds.), The SAGES Manual of Fluorescence-Guided
Surgery, https://doi.org/10.1007/978-3-031-40685-0_2
31
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D. Hui et al.
8mm [2, 3]. The depth of penetration and the working distance
of each device determine which structures can be identied
with uorescence imaging.
FGS utilizes a specialized camera with an NIR detector to
relay images in real time. An excitation light source is used to
activate uorophores within target tissue [4, 5]. Excitation and
emission wavelengths are specic for each device. These wavelengths are generally within a similar range and are limited by
clinically available uorophores [2, 3, 6, 7].
Fluorescence imaging requires a uorophore or an NIR- emitting
LED to create near-infrared images. Fluorophores are compounds
that release light with excitation and are the primary means for
visualizing key structures in FGS.In 2021, available uorophores
include uorescein, methylene blue (MB), 5- aminolevulinic acid
(5-ALA), and indocyanine green (ICG) [8]. ICG is the most frequently used uorophore due to its ease of use and low side effect
prole. It is easy to mix and administer intravenously in the pre-op
or intraoperative setting. Its emission wavelength does not overlap
with visible light; this minimizes scattering effect and background
noise that may obscure visualization [8–10].
Fluorescein has an excitation wavelength of 495nm and an
emission wavelength of 519nm. MB has an excitation wavelength
of 668nm and an emission wavelength of 688nm. 5-ALA has an
excitation wavelength of 380–440 and an emission wavelength of
620–634nm, depending on the acidity of its solution. Fluorescein,
MB, and 5-ALA have emission wavelengths within the visible
light wavelength and are therefore not ideal uorophores for
FGS.The excitation and emission wavelengths of ICG are 740–
900 and 800–860nm ranges, respectively, and are ideal for use
with NIR cameras [11–13].
Fluoroscopic devices have become increasingly prevalent in
the opening room since the Food and Drug Administration (FDA)
approved the Novadaq SPY imaging system in 2005 [6, 12]. FGS
has shown utility in a wide range of procedures, including intraoperative angiography, perfusion assessment, tissue plane identication, biliary structure identication, and lymphangiography
[5, 14]. As the technology to uorescently label specic tissues
continues to advance, FGS devices will become increasingly
more commonplace in the operative suite[8, 9].
2 Current Fluorescence-Guided Platforms andDevices
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Indocyanine Green (ICG) Dye
Indocyanine green (ICG) was developed in 1955 by Kodak
Research Laboratory for NIR photography. It was approved for
clinical use in 1959 for assessment of cardiac output. It was later
found to be excreted exclusively by the liver with uptake by hepatocytes and excretion via bile which prompted its use in the assessment of hepatic function [15]. ICG was found to be useful in the
assessment of choroidal blood ow and has since been utilized in
an increasing number of angiographic and lymphangiographic
modalities [11]. Use of ICG is heavily favored for uorescenceguided surgery as it is a water-soluble dye with emission wavelength of approximately 800 nm. The autouorescence at this
wavelength in normal tissue is low which increases the signal-tonoise ratio and improves sensitivity of visualized target anatomy
following excitation. ICG has a relatively low toxicity prole with
a half-life at approximately 3min. It readily binds lipoproteins in
the blood without systemic effects and is very well tolerated by
patients [16, 17]. It is non-nephrotoxic and has a low side effect
prole. It can be used multiple times during the same surgery. ICG
requires fresh preparation with 6h of viable use.
Contraindication for use of ICG is anaphylaxis. Recommended
dosing, mode of administration, timing for administration, and
timing for visualization are per manufacturer recommendations
[17]. General recommendations are as follows:
• Angiographic perfusion: 2.5 mg given intravenously during
surgery with visualization in less than 1min.
• Biliary assessment: 5 mg given intravenously up to 1–7 h
before surgery with direct visualization.
• Lymph node mapping: 2.5mg given directly around target tis-
sue during surgery with visualization in 15–30min.
Fluorescence-Guided Systems andDevices
The rst FDA-approved system for FGS is the Novadaq SPY
system developed in 2005. Many of the rst FGS systems were
used in open surgery via a cart-based platform that contained
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an excitation laser and imager to capture NIR light. These cartbased systems have largely been replaced by handheld devices
and have been adapted to laparoscopic, robotic, and microscopic systems. As FGS continues to advance, devices may
integrate with augmented reality systems and wearable technology.
D. Hui et al.
Open Surgical Systems
The two categories of open FGS systems are cart-based and handheld devices. Cart-based systems offer visualization of key structures while freeing the surgeon’s hands to manipulate tissue and
operate while assessing in real time. The working distance for
such devices is xed, but offers a wide area of visualization in
assessing overall perfusion in reconstructive procedures. Handheld
devices also offer visualization of key structures in real time with
some systems having the option for mounting the imager on an
adjustable securing arm. The size and convenience of handheld
devices offer a greater degree of freedom and maneuverability
with a exible working distance [1, 3, 6].
Cart-Based Platform
SPY Elite System [Spy Elite Intraoperative Perfusion
Assessment System (LC3000, SP 3000)]—Stryker, Kalamazoo,
Michigan, USA
The SPY Elite System (Fig.2.1a) is the updated version of the
rst clinically available FGS platform, the SPY System. The SPY
Elite System consists of a mounted imaging head that can be positioned above the surgical eld in order to obtain NIR images.
SPY Elite System Components
The system includes the following: imaging console (radiation
source and mage detector), dual display (1080p resolution),
bc
2 Current Fluorescence-Guided Platforms andDevices
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a
Fig. 2.1 (a) SPY Elite cart-based uorescence system—Photo courtesy of
Stryker. (b) SPY Elite uorescence image—Photo courtesy of Stryker. (c)
SPY-Q image captured for qualitative assessment of tissue perfusion—Photo
courtesy of Stryker
CINEVAQ Software, sterile drape, and SPY AGENT GREEN
(ICG)—25mg vials.
For use, the SPY Elite System should be positioned in the
operating room to provide optimal visualization of the monitor
located on the cart. The imaging console is sterilely draped, using
the included clear drapes, and positioned over the surgical eld.
The imaging console is attached to a exible arm mount connected directly to the cart system, which can be easily positioned
and removed from the operative eld while maintaining sterility.
The working distance of the imaging console is 30cm and is the
ideal distance from the target anatomy to obtain accurate uorescence images. SPY mode uorescence is activated from the cart
or the “laser on” button on the left side of the imaging console.
The radiation source is a class 3R laser that activates a uorophore to produce emission wavelengths between 825 and 850nm.
NIR images are captured through a charge-coupled device camera
and relay real-time images on the display attached to the system
cart. The preferred uorophore with SPY Elite System is SPY
AGENT GREEN (ICG), and its timing for use depends on the
indication for use [18, 19].
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