Recent Advances and Applications of Image-Guided Surgery

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 36236

Special Issue Editors


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Guest Editor
Department of Surgery, Leiden University Medical Center, 2333 Leiden, The Netherlands
Interests: vascular surgery; real-time imaging; image-guided surgery; near-infrared fluorescence; optical imaging; perfusion assessment

E-Mail Website
Guest Editor
Department of Surgery, Leiden University Medical Center, 2333 Leiden, The Netherlands
Interests: hepatobiliary surgery; colorectal cancer; image-guided surgery; molecular imaging

Special Issue Information

Dear Colleagues,

During the last decade, image-guided surgery has been studied and implemented in a multidisciplinary setting. Several techniques in a multitude of disciplines were developed to aid surgeons to operate more accurately, faster, and with less collateral damage. This Special Issue focuses on the recent advances and novel applications of image-guided surgery. Original research and reviews on near-infrared fluorescence imaging, spectral imaging, (opto) acoustic imaging, tomography, and multimodal imaging, among other techniques focusing on image-guided surgery, qualify to be included in this Special Issue. Both preclinical and clinical studies can be submitted.

This Special Issue is now open for submissions. Prospective authors should first send a short abstract or tentative title to the editorial office. If the editors deem the topic to be appropriate for inclusion in the Special Issue, the author will be encouraged to submit a full manuscript.

Dr. Joost R. van der Vorst
Dr. Alexander Vahrmeijer
Guest Editors

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Keywords

  • image-guided surgery
  • real-time imaging
  • near-infrared fluorescence imaging
  • spectral imaging
  • (opto)acoustic imaging
  • tomography
  • multimodal imaging

Published Papers (16 papers)

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Research

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18 pages, 3687 KiB  
Article
Optimizing Indocyanine Green Dosage for Near-Infrared Fluorescence Perfusion Assessment in Bowel Anastomosis: A Prospective, Systematic Dose-Ranging Study
by Leonard A. Lobbes, Katharina Schier, Kasper Tiebie, Nelly Scheidel, Ioannis Pozios, Richelle J. M. Hoveling and Benjamin Weixler
Life 2024, 14(2), 186; https://doi.org/10.3390/life14020186 - 26 Jan 2024
Viewed by 988
Abstract
Background: Indocyanine green (ICG) near-infrared fluorescence (NIRF) has emerged as a promising technique for visualizing tissue perfusion. However, within the wide range of dosages and imaging conditions currently being applied, the optimal dosage of ICG remains unclear. This study aimed to investigate the [...] Read more.
Background: Indocyanine green (ICG) near-infrared fluorescence (NIRF) has emerged as a promising technique for visualizing tissue perfusion. However, within the wide range of dosages and imaging conditions currently being applied, the optimal dosage of ICG remains unclear. This study aimed to investigate the feasibility and implications of implementing lower dosages of ICG than commonly used for visual and quantitative perfusion assessment in a standardized setting. Methods: A prospective single-center cohort study was conducted on patients undergoing ileostomy reversal by hand-sewn anastomosis. ICG-NIRF visualization was performed before (T1) and after (T2) anastomosis with one of four different dosages of ICG (5 mg, 2.5 mg, 1.25 mg, or 0.625 mg) and recorded. Postoperatively, each visualization was evaluated for signal strength, completeness, and homogeneity of fluorescence. Additionally, perfusion graphs were generated by a software-based quantitative perfusion assessment, allowing an analysis of perfusion parameters. Statistical analysis comparing the effect of the investigated dosages on these parameters was performed. Results: In total, 40 patients were investigated. Visual evaluation demonstrated strong, complete, and homogeneous fluorescence signals across all dosages. Perfusion graph assessment revealed a consistent shape for all dosages (ingress followed by egress phase). While the average signal intensity decreased with dosage, it was sufficient to enable perfusion assessment even at the lowest dosages of 1.25 mg and 0.625 mg of ICG. The baseline intensity at T2 (the second intraoperative visualization) significantly decreased with dosage. The slope of the egress phase steepened with decreasing dosage. Conclusions: Lower dosages of ICG were sufficient for intraoperative perfusion assessment, while causing lower residual fluorescence and quicker egress in subsequent visualizations. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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9 pages, 909 KiB  
Communication
The Value of Indocyanine Green Image-Guided Surgery in Patients with Primary Liver Tumors and Liver Metastases
by Benjamin Weixler, Leonard A. Lobbes, Luis Scheiner, Johannes C. Lauscher, Sebastian M. Staubli, Markus Zuber and Dimitri A. Raptis
Life 2023, 13(6), 1290; https://doi.org/10.3390/life13061290 - 31 May 2023
Cited by 3 | Viewed by 1629
Abstract
Introduction: Successful R0 resection is crucial for the survival of patients with primary liver cancer (PLC) or liver metastases. Up to date, surgical resection lacks a sensitive, real-time intraoperative imaging modality to determine R0 resection. Real-time intraoperative visualization with near-infrared light fluorescence (NIRF) [...] Read more.
Introduction: Successful R0 resection is crucial for the survival of patients with primary liver cancer (PLC) or liver metastases. Up to date, surgical resection lacks a sensitive, real-time intraoperative imaging modality to determine R0 resection. Real-time intraoperative visualization with near-infrared light fluorescence (NIRF) using indocyanine green (ICG) may have the potential to meet this demand. This study evaluates the value of ICG visualization in PLC and liver metastases surgery regarding R0 resection rates. Materials and Methods: Patients with PLC or liver metastases were included in this prospective cohort study. ICG 10 mg was administered intravenously 24 h before surgery. Real-time intraoperative NIRF visualization was created with the SpectrumTM fluorescence imaging camera system. First, all liver segments were inspected with the fluorescence imaging system and intraoperative ultrasound for identification of the known tumor, as well as additional lesions, and were compared to preoperative MRI images. PLC, liver metastases, and additional lesions were then resected according to oncological principles. In all resected specimens, the resection margins were analyzed with the fluorescence imaging system for ICG-positive spots immediately after resection. Histology of additional detected lesions, as well as ICG fluorescence compared to histological resection margins, were assessed. Results: Of the 66 included patients, median age was 65.5 years (IQR 58.7–73.9), 27 (40.9%) were female, and 18 (27.3%) were operated on laparoscopically. Additional ICG-positive lesions were detected in 23 (35.4%) patients, of which 9 (29%) were malignant. In patients with no fluorescent signal at the resection margin, R0 rate was 93.9%, R1 rate was 6.1%, and R2 rate was 0% compared to an ICG-positive resection margin with an R0 rate of 64.3%, R1 rate of 21.4%, and R2 rate of 14.3% (p = 0.005). One- and two-year overall survival rates were 95.2% and 88.4%, respectively. Conclusion: The presented study provides significant evidence that ICG NIRF guidance helps to identify R0 resection intraoperatively. This offers true potential to verify radical resection and improve patient outcomes. Furthermore, implementation of NIRF-guided imaging in liver tumor surgery allows us to detect a considerable amount of additional malignant lesions. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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17 pages, 2956 KiB  
Article
Feasibility of Novel Software-Based Perfusion Indicators for the Ileal J-Pouch—On the Path towards Objective and Quantifiable Intraoperative Perfusion Assessment with Indocyanine Green Near-Infrared Fluorescence
by Leonard A. Lobbes, Richelle J. M. Hoveling, Susanne Berns, Leonard R. Schmidt, Rahel M. Strobel, Christian Schineis, Johannes C. Lauscher, Katharina Beyer and Benjamin Weixler
Life 2022, 12(8), 1144; https://doi.org/10.3390/life12081144 - 28 Jul 2022
Cited by 2 | Viewed by 1704
Abstract
Background: In restorative proctocolectomy with ileal J-pouch, perfusion assessment is vital to prevent complications such as anastomotic leak (AL). Indocyanine green near-infrared fluorescence (ICG-NIRF) is gaining popularity, while its interpretation and relevance remain subjective. This study aimed to evaluate a standardized ICG-NIRF imaging [...] Read more.
Background: In restorative proctocolectomy with ileal J-pouch, perfusion assessment is vital to prevent complications such as anastomotic leak (AL). Indocyanine green near-infrared fluorescence (ICG-NIRF) is gaining popularity, while its interpretation and relevance remain subjective. This study aimed to evaluate a standardized ICG-NIRF imaging protocol combined with a novel, software-based assessment to detect areas of impaired perfusion and a possible correlation with AL of the pouch. Methods: In this prospective study, patients undergoing ileal J-pouch for ulcerative colitis at an inflammatory bowel disease (IBD) referral center were included. Intraoperatively, strictly standardized ICG-NIRF visualization was performed and video-recorded. Postoperatively, a specific software was utilized to determine the change in fluorescence intensity per second (i/s) for systematic regions of interest, generating perfusion-time curves and a pixel-to-pixel map. These were analysed in detail and correlated with clinical outcome (primary end point: AL within 30 days; clearly defined and screened for by pouchoscopy). Results: Four out of 18 included patients developed AL of the ileal pouch-anal anastomosis (IPAA). In the AL group, the perfusion curves on the area adjacent to the IPAA (pouch apex) displayed considerably lower ingress/inflow (median = 1.7; range = 8.5; interquartile-range = 3.8 i/s) and egress/outflow (median = −0.1; range = 0.7; interquartile-range = 0.5 i/s) values than in the non-AL group (ingress: median = 4.3; range = 10.3; interquartile-range = 4.0 i/s); egress: median = (−1.1); range = 3.9; interquartile range = 1.0 i/s). This was confirmed by further novel parameters of pouch perfusion (maximum ingress; maximum egress) and pixel-to-pixel analysis. Conclusions: This study presents the feasibility of a novel methodology to precisely assess pouch perfusion with ICG-NIRF, identifying comparable, quantifiable, and objective parameters to potentially detect perfusion-associated complications in surgery in real-time. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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9 pages, 1229 KiB  
Article
In Vivo Imaging Evaluation of Fluorescence Intensity at Tail Emission of Near-Infrared-I (NIR-I) Fluorophores in a Porcine Model
by María Rita Rodríguez-Luna, Nariaki Okamoto, Mahdi Al-Taher, Deborah S. Keller, Lorenzo Cinelli, Anila Hoskere Ashoka, Andrey S. Klymchenko, Jacques Marescaux and Michele Diana
Life 2022, 12(8), 1123; https://doi.org/10.3390/life12081123 - 27 Jul 2022
Cited by 4 | Viewed by 2417
Abstract
Over the last decade fluorescence-guided surgery has been primarily focused on the NIR-I window. However, the NIR-I window has constraints, such as limited penetration and scattering. Consequently, exploring the performance of NIR-I dyes at longer wavelengths (i.e., the NIR-II window) is crucial to [...] Read more.
Over the last decade fluorescence-guided surgery has been primarily focused on the NIR-I window. However, the NIR-I window has constraints, such as limited penetration and scattering. Consequently, exploring the performance of NIR-I dyes at longer wavelengths (i.e., the NIR-II window) is crucial to expanding its application. Two fluorophores were used in three pigs to identify the mean fluorescence intensity (MFI) using two commercially available NIR-I and NIR-II cameras. The near-infrared coating of equipment (NICE) was used to identify endoluminal surgical catheters and indocyanine green (ICG) for common bile duct (CBD) characterization. The NIR-II window evaluation showed an MFI of 0.4 arbitrary units (a.u.) ± 0.106 a.u. in small bowel NICE-coated catheters and an MFI of 0.09 a.u. ± 0.039 a.u. in gastric ones. In CBD characterization, the ICG MFI was 0.12 a.u. ± 0.027 a.u., 0.18 a.u. ± 0.100 a.u., and 0.22 a.u. ± 0.041 a.u. at 5, 35, and 65 min, respectively. This in vivo imaging evaluation of NIR-I dyes confirms its application in the NIR-II domain. To the best of our knowledge, this is the first study assessing the MIF of NICE in the NIR-II window using a commercially available system. Further comparative trials are necessary to determine the superiority of NIR-II imaging systems. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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11 pages, 2091 KiB  
Article
Integration of Three-Dimensional Liver Models in a Multimodal Image-Guided Robotic Liver Surgery Cockpit
by Okker D. Bijlstra, Alexander Broersen, Timo T. M. Oosterveer, Robin A. Faber, Friso B. Achterberg, Rob Hurks, Mark C. Burgmans, Jouke Dijkstra, J. Sven D. Mieog, Alexander L. Vahrmeijer and Rutger-Jan Swijnenburg
Life 2022, 12(5), 667; https://doi.org/10.3390/life12050667 - 30 Apr 2022
Cited by 8 | Viewed by 2536
Abstract
Background: Robotic liver surgery represents the most recent evolution in the field of minimally-invasive liver surgery. For planning and guidance of liver resections, surgeons currently rely on preoperative 2-dimensional (2D) CT and/or MR imaging and intraoperative ultrasonography. Translating 2D images into digital 3-dimensional [...] Read more.
Background: Robotic liver surgery represents the most recent evolution in the field of minimally-invasive liver surgery. For planning and guidance of liver resections, surgeons currently rely on preoperative 2-dimensional (2D) CT and/or MR imaging and intraoperative ultrasonography. Translating 2D images into digital 3-dimensional (3D) models may improve both preoperative planning and surgical guidance. The da Vinci® robotic surgical system is a platform suitable for the integration of multiple imaging modalities into one single view. In this study, we describe multimodal imaging options and introduce the Robotic Liver Surgery Cockpit; Methods: in-house developed software was used and validated for segmentation and registration to create a virtual reality 3D model of the liver based on preoperative imaging. The accuracy of the 3D models in the clinical setting was objectively assessed in 15 patients by measuring tumor diameters and subjectively with a postoperative conducted questionnaire; Results: Implementation and applicability of the 3D model in the surgical cockpit was feasible in all patients and the quality of the 3D reconstructions was high in 14 (93%) of cases. Tumor diameters measured on CT and/or MR imaging were comparable to automated measurements using the segmentation software and 3D models; Conclusions: the 3D model was successfully incorporated in the robotic surgery console as part of a multimodality imaging platform and aided the surgeon in planning and guidance of the resection. Future studies should focus on further automation of 3D rendering and progress into augmented reality. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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13 pages, 4399 KiB  
Article
Use of Image-Guided Surgical Navigation during Resection of Locally Recurrent Rectal Cancer
by Harald C. Groen, Anne G. den Hartog, Wouter J. Heerink, Koert F. D. Kuhlmann, Niels F. M. Kok, Ruben van Veen, Marijn A. J. Hiep, Petur Snaebjornsson, Brechtje A. Grotenhuis, Geerard L. Beets, Arend G. J. Aalbers and Theo J. M. Ruers
Life 2022, 12(5), 645; https://doi.org/10.3390/life12050645 - 27 Apr 2022
Cited by 7 | Viewed by 2110 | Correction
Abstract
Surgery for locally recurrent rectal cancer (LRRC) presents several challenges, which is why the percentage of inadequate resections of these tumors is high. In this exploratory study, we evaluate the use of image-guided surgical navigation during resection of LRRC. Patients who were scheduled [...] Read more.
Surgery for locally recurrent rectal cancer (LRRC) presents several challenges, which is why the percentage of inadequate resections of these tumors is high. In this exploratory study, we evaluate the use of image-guided surgical navigation during resection of LRRC. Patients who were scheduled to undergo surgical resection of LRRC who were deemed by the multidisciplinary team to be at a high risk of inadequate tumor resection were selected to undergo surgical navigation. The risk of inadequate surgery was further determined by the proximity of the tumor to critical anatomical structures. Workflow characteristics of the surgical navigation procedure were evaluated, while the surgical outcome was determined by the status of the resection margin. In total, 20 patients were analyzed. For all procedures, surgical navigation was completed successfully and demonstrated to be accurate, while no complications related to the surgical navigation were discerned. Radical resection was achieved in 14 cases (70%). In five cases (25%), a tumor-positive resection margin (R1) was anticipated during surgery, as extensive radical resection was determined to be compromised. These patients all received intraoperative brachytherapy. In one case (5%), an unexpected R1 resection was performed. Surgical navigation during resection of LRRC is thus safe and feasible and enables accurate surgical guidance. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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9 pages, 1757 KiB  
Article
Safety and Efficacy of Cone-Beam Computed Tomography-Guided Lung Tumor Localization with a Near-Infrared Marker: A Retrospective Study of 175 Patients
by Chia-Jung Chang, Chi-Hsuan Lu, Xing Gao, Hsin-Yueh Fang and Yin-Kai Chao
Life 2022, 12(4), 494; https://doi.org/10.3390/life12040494 - 28 Mar 2022
Cited by 3 | Viewed by 1743
Abstract
Preoperative localization holds promise for overcoming the limitations of video-assisted thoracoscopic surgery (VATS) in the treatment of impalpable lung nodules. The purpose of this study was to assess the safety and efficacy of cone-beam computed tomography (CBCT)-guided localization using near-infrared (NIR) marking. Between [...] Read more.
Preoperative localization holds promise for overcoming the limitations of video-assisted thoracoscopic surgery (VATS) in the treatment of impalpable lung nodules. The purpose of this study was to assess the safety and efficacy of cone-beam computed tomography (CBCT)-guided localization using near-infrared (NIR) marking. Between 2017 and 2021, patients presenting with a solitary pulmonary nodule (SPN) who had undergone CBCT-guided lesion localization with indocyanine green (ICG) in a hybrid operating room were included. The primary outcomes were the efficacy of localization and the occurrence of complications. The study cohort consisted of 175 patients with the mean age of 58.76 years. The mean size and depth of the 175 SPNs were 8.34 mm and 5.3 mm, respectively. The mean time required for lesion marking was 14.71 min. Upon thoracoscopic inspection, the NIR tattoo was detected in the vast majority of the study participants (98.3%). An utility thoracotomy to allow digital palpation was required in two of the three patients in whom the tattoo was not identifiable. The perioperative survival rate was 100%, and the mean length of hospital stay was 3.09 days. We conclude that needle localization with ICG injection is a safe and feasible technique to localize SPNs prior to resection. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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14 pages, 3018 KiB  
Article
Objective Perfusion Assessment in Gracilis Muscle Interposition—A Novel Software-Based Approach to Indocyanine Green Derived Near-Infrared Fluorescence in Reconstructive Surgery
by Leonard A. Lobbes, Richelle J. M. Hoveling, Leonard R. Schmidt, Susanne Berns and Benjamin Weixler
Life 2022, 12(2), 278; https://doi.org/10.3390/life12020278 - 13 Feb 2022
Cited by 4 | Viewed by 2164
Abstract
Background: Gracilis muscle interposition (GMI) is an established treatment option for complex perineal fistulas and reconstruction. The outcome is limited by complications such as necrosis, impaired wound healing and fistula persistence or recurrence. Quantifiable methods of assessing muscle flap perfusion intraoperatively are lacking. [...] Read more.
Background: Gracilis muscle interposition (GMI) is an established treatment option for complex perineal fistulas and reconstruction. The outcome is limited by complications such as necrosis, impaired wound healing and fistula persistence or recurrence. Quantifiable methods of assessing muscle flap perfusion intraoperatively are lacking. This study evaluates a novel and objective software-based assessment of indocyanine green near-infrared fluorescence (ICG-NIRF) in GMI. Methods: Intraoperative ICG-NIRF visualization data of five patients with inflammatory bowel disease (IBD) undergoing GMI for perineal fistula and reconstruction were analyzed retrospectively. A new software was utilized to generate perfusion curves for the specific regions of interest (ROIs) of each GMI by depicting the fluorescence intensity over time. Additionally, a pixel-to-pixel and perfusion zone analysis were performed. The findings were correlated with the clinical outcome. Results: Four patients underwent GMI without postoperative complications within 3 months. The novel perfusion indicators identified here (shape of the perfusion curve, maximum slope value, distribution and range) indicated adequate perfusion. In one patient, GMI failed. In this case, the perfusion indicators suggested impaired perfusion. Conclusions: We present a novel, software-based approach for ICG-NIRF perfusion assessment, identifying previously unknown objective indicators of muscle flap perfusion. Ready for intraoperative real-time use, this method has considerable potential to optimize GMI surgery in the future. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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12 pages, 21205 KiB  
Article
Quantitative Fluorescence Imaging of Perfusion—An Algorithm to Predict Anastomotic Leakage
by Sanne M. Jansen, Daniel M. de Bruin, Leah S. Wilk, Mark I. van Berge Henegouwen, Simon D. Strackee, Suzanne S. Gisbertz, Ed T. van Bavel and Ton G. van Leeuwen
Life 2022, 12(2), 249; https://doi.org/10.3390/life12020249 - 8 Feb 2022
Cited by 3 | Viewed by 1921
Abstract
This study tests fluorescence imaging-derived quantitative parameters for perfusion evaluation of the gastric tube during surgery and correlates these parameters with patient outcomes in terms of anastomotic leakage. Poor fundus perfusion is seen as a major factor for the development of anastomotic leakage [...] Read more.
This study tests fluorescence imaging-derived quantitative parameters for perfusion evaluation of the gastric tube during surgery and correlates these parameters with patient outcomes in terms of anastomotic leakage. Poor fundus perfusion is seen as a major factor for the development of anastomotic leakage and strictures. Fluorescence perfusion imaging may reduce the incidence of complications. Parameters for the quantification of the fluorescence signal are still lacking. Quantitative parameters in terms of maximal intensity, mean slope and influx timepoint were tested for significant differences between four perfusion areas of the gastric tube in 22 patients with a repeated ANOVA test. These parameters were compared with patient outcomes. Maximal intensity, mean slope and influx timepoint were significantly different between the base of the gastric tube and the fundus (p < 0.0001). Patients who developed anastomotic leakage showed a mean slope of almost 0 in Location 4. The distance of the demarcation of ICG to the fundus was significantly higher in the three patients who developed anastomotic leakage (p < 0.0001). This study presents quantitative intra-operative perfusion imaging with fluorescence. Quantification of the fluorescence signal allows for early risk stratification of necrosis. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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10 pages, 482 KiB  
Article
Near-Infrared Fluorescence Imaging for the Intraoperative Detection of Endometriosis: A Pilot Study
by Mahdi Al-Taher, Jacqueline van den Bos, Ivon Terink, Sander van Kuijk, Nehalennia van Hanegem, Nicole Bouvy, Marlies Bongers, Laurents Stassen and Arianne Lim
Life 2022, 12(1), 15; https://doi.org/10.3390/life12010015 - 23 Dec 2021
Cited by 4 | Viewed by 2490
Abstract
Introduction: Endometriosis surgery is associated with a high risk of reoperation due to an insufficient recognition of endometriotic lesions. Our aim was to explore the role of near-infrared fluorescence (NIRF) imaging for the visualization and identification of endometriotic lesions next to conventional white [...] Read more.
Introduction: Endometriosis surgery is associated with a high risk of reoperation due to an insufficient recognition of endometriotic lesions. Our aim was to explore the role of near-infrared fluorescence (NIRF) imaging for the visualization and identification of endometriotic lesions next to conventional white light (WL) laparoscopy. Materials and methods: Fifteen women scheduled for diagnostic laparoscopy in whom peritoneal endometriosis was suspected were included. Peritoneal exploration was performed in WL, followed by NIRF imaging after ICG administration. Biopsies of all the suspected lesions were taken for histological examination. Subjective evaluations of the equipment and NIRF imaging were also performed. Results: Only 61% (44) of the biopsied lesions contained endometriosis. The positive predictive value (PPV) for the lesions found in WL was 64%. The PPV for the lesions found under NIRF was 69% and the PPV for the lesions found in both modes was 61%. The mean satisfaction of surgeons regarding the surgical procedure and equipment using both imaging modalities was 6.5 (p > 0.05) on a 10 item Likert scale and the mean satisfaction with the quality of the NIRF imaging was 7.4 (p > 0.05). Conclusion: In this study, the additional value of NIRF imaging, although feasible, was found to be limited for the intraoperative detection of endometriotic lesions. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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Review

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19 pages, 2117 KiB  
Review
Heterogeneity in Utilization of Optical Imaging Guided Surgery for Identifying or Preserving the Parathyroid Glands—A Meta-Narrative Review
by Eline A. Feitsma, Hugo M. Schouw, Milou E. Noltes, Wido Heeman, Wendy Kelder, Gooitzen M. van Dam and Schelto Kruijff
Life 2022, 12(3), 388; https://doi.org/10.3390/life12030388 - 8 Mar 2022
Cited by 5 | Viewed by 2688
Abstract
Background: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy. Over the past years, optical imaging techniques, such as parathyroid autofluorescence, indocyanine green (ICG) angiography, and laser speckle contrast imaging (LSCI) have been employed to save parathyroid glands during thyroid surgery. This [...] Read more.
Background: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy. Over the past years, optical imaging techniques, such as parathyroid autofluorescence, indocyanine green (ICG) angiography, and laser speckle contrast imaging (LSCI) have been employed to save parathyroid glands during thyroid surgery. This study provides an overview of the utilized methods of the optical imaging techniques during total thyroidectomy for parathyroid gland identification and preservation. Methods: PUBMED, EMBASE and Web of Science were searched for studies written in the English language utilizing parathyroid autofluorescence, ICG-angiography, or LSCI during total thyroidectomy to support parathyroid gland identification or preservation. Case reports, reviews, meta-analyses, animal studies, and post-mortem studies were excluded after the title and abstract screening. The data of the studies were analyzed qualitatively, with a focus on the methodologies employed. Results: In total, 59 articles were included with a total of 6190 patients. Overall, 38 studies reported using parathyroid autofluorescence, 24 using ICG-angiography, and 2 using LSCI. The heterogeneity between the utilized methodology in the studies was large, and in particular, regarding study protocols, imaging techniques, and the standardization of the imaging protocol. Conclusion: The diverse application of optical imaging techniques and a lack of standardization and quantification leads to heterogeneous conclusions regarding their clinical value. Worldwide consensus on imaging protocols is needed to establish the clinical utility of these techniques for parathyroid gland identification and preservation. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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Other

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1 pages, 162 KiB  
Correction
Correction: Groen et al. Use of Image-Guided Surgical Navigation during Resection of Locally Recurrent Rectal Cancer. Life 2022, 12, 645
by Harald C. Groen, Anne G. den Hartog, Wouter J. Heerink, Koert F. D. Kuhlmann, Niels F. M. Kok, Ruben van Veen, Marijn A. J. Hiep, Petur Snaebjornsson, Brechtje A. Grotenhuis, Geerard L. Beets, Arend G. J. Aalbers and Theo J. M. Ruers
Life 2023, 13(3), 678; https://doi.org/10.3390/life13030678 - 2 Mar 2023
Viewed by 840
Abstract
The authors wish to make the following corrections to this paper [...] Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
8 pages, 4712 KiB  
Technical Note
Laparoscopic Laser Speckle Contrast Imaging Can Visualize Anastomotic Perfusion: A Demonstration in a Porcine Model
by Aurelia Wildeboer, Wido Heeman, Arne van der Bilt, Christiaan Hoff, Joost Calon, E. Christiaan Boerma, Mahdi Al-Taher and Nicole Bouvy
Life 2022, 12(8), 1251; https://doi.org/10.3390/life12081251 - 16 Aug 2022
Cited by 4 | Viewed by 1890
Abstract
Background: Intestinal resection causes inevitable vascular damage, which cannot always be seen during an intraoperative clinical assessment of local intestinal perfusion. If left unaltered, impaired perfusion can lead to complications, such as anastomotic leakage (AL). Therefore, we demonstrate the use of a novel [...] Read more.
Background: Intestinal resection causes inevitable vascular damage, which cannot always be seen during an intraoperative clinical assessment of local intestinal perfusion. If left unaltered, impaired perfusion can lead to complications, such as anastomotic leakage (AL). Therefore, we demonstrate the use of a novel laparoscopic laser speckle contrast imaging (LSCI)-based approach in order to assess local intestinal perfusion during the construction of intestinal anastomoses. Methods: Three segments were isolated from the small intestine of a pig, while the perfusion of each was compromised by coagulating 7–8 mesenteric arteries. Both clinical assessments and LSCI were used to detect the induced perfusion deficits and to subsequently guide a transection in either a well perfused, marginally perfused, or poorly perfused tissue area within the segment. Bowel ends were then utilized for the creation of three differently perfused anastomoses: well perfused/well perfused (anastomosis segment 1), well perfused/poorly perfused (anastomosis segment 2), and poorly perfused/poorly perfused (anastomosis segment 3). After construction of the anastomoses, a final perfusion assessment using both clinical assessment and LSCI was executed in order to evaluate the vascular viability of the anastomosis. Results: Laparoscopic LSCI enabled continuous assessment of local intestinal perfusion and allowed for detection of perfusion deficits in real time. The imaging feedback precisely guided the surgical procedure, and, when evaluating the final anastomotic perfusion, LSCI was able to visualize the varying degrees of perfusion, whereas standard clinical assessment yielded only minor differences in visual appearance of the tissue. Conclusions: In this technical note, we demonstrate a novel LSCI-based approach for intraoperative perfusion assessment. With its ability to continuously visualize perfusion in real time, laparoscopic LSCI has significant potential for the optimization of anastomotic surgery in the near future. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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30 pages, 1483 KiB  
Systematic Review
Near-Infrared Fluorescence Tumor-Targeted Imaging in Lung Cancer: A Systematic Review
by Lisanne K. A. Neijenhuis, Lysanne D. A. N. de Myunck, Okker D. Bijlstra, Peter J. K. Kuppen, Denise E. Hilling, Frank J. Borm, Danielle Cohen, J. Sven D. Mieog, Willem H. Steup, Jerry Braun, Jacobus Burggraaf, Alexander L. Vahrmeijer and Merlijn Hutteman
Life 2022, 12(3), 446; https://doi.org/10.3390/life12030446 - 17 Mar 2022
Cited by 14 | Viewed by 3869
Abstract
Lung cancer is the most common cancer type worldwide, with non-small cell lung cancer (NSCLC) being the most common subtype. Non-disseminated NSCLC is mainly treated with surgical resection. The intraoperative detection of lung cancer can be challenging, since small and deeply located pulmonary [...] Read more.
Lung cancer is the most common cancer type worldwide, with non-small cell lung cancer (NSCLC) being the most common subtype. Non-disseminated NSCLC is mainly treated with surgical resection. The intraoperative detection of lung cancer can be challenging, since small and deeply located pulmonary nodules can be invisible under white light. Due to the increasing use of minimally invasive surgical techniques, tactile information is often reduced. Therefore, several intraoperative imaging techniques have been tested to localize pulmonary nodules, of which near-infrared (NIR) fluorescence is an emerging modality. In this systematic review, the available literature on fluorescence imaging of lung cancers is presented, which shows that NIR fluorescence-guided lung surgery has the potential to identify the tumor during surgery, detect additional lesions and prevent tumor-positive resection margins. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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11 pages, 2655 KiB  
Systematic Review
Near-Infrared Fluorescence with Indocyanine Green to Assess Bone Perfusion: A Systematic Review
by Marlies Michi, Max Madu, Henri A. H. Winters, Daniel M. de Bruin, Joost R. van der Vorst and Caroline Driessen
Life 2022, 12(2), 154; https://doi.org/10.3390/life12020154 - 21 Jan 2022
Cited by 6 | Viewed by 2414
Abstract
Background: Adequate perfusion of a bone flap is essential for successful reconstruction of osseous defects. Unfortunately, complications related to inadequate bone perfusion are common. Near-infrared fluorescence (NIRF) imaging enables intraoperative visualization of perfusion. NIRF has been investigated in reconstructive surgery to aid the [...] Read more.
Background: Adequate perfusion of a bone flap is essential for successful reconstruction of osseous defects. Unfortunately, complications related to inadequate bone perfusion are common. Near-infrared fluorescence (NIRF) imaging enables intraoperative visualization of perfusion. NIRF has been investigated in reconstructive surgery to aid the surgeon in clinical perioperative assessment of soft tissue perfusion. However, little is known on the beneficial use of NIRF to assess bone perfusion. Therefore, the aim of this review was to search for studies evaluating NIRF to assess bone perfusion. Methods: A systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, was performed. Studies up to October 2021 were included. We extracted data regarding the study population, size and design, reported objective fluorescence parameters and the methodology used for fluorescence imaging and processing. Results: Ten articles were included. Studies reported unevenly on the protocol used for NIRF imaging. Five studies reported objective parameters. Absolute and relative perfusion parameters and parameters derived from maximum fluorescence were reported. The clinical significance of these parameters has not been evaluated in humans. Conclusion: The evidence on bone perfusion as measured with NIRF is limited. More clinical studies are required. Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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18 pages, 2518 KiB  
Systematic Review
Near-Infrared Spectroscopy (NIRS) versus Hyperspectral Imaging (HSI) to Detect Flap Failure in Reconstructive Surgery: A Systematic Review
by Anouk A. M. A. Lindelauf, Alexander G. Saelmans, Sander M. J. van Kuijk, René R. W. J. van der Hulst and Rutger M. Schols
Life 2022, 12(1), 65; https://doi.org/10.3390/life12010065 (registering DOI) - 3 Jan 2022
Cited by 12 | Viewed by 2553
Abstract
Rapid identification of possible vascular compromise in free flap reconstruction to minimize time to reoperation improves achieving free flap salvage. Subjective clinical assessment, often complemented with handheld Doppler, is the golden standard for flap monitoring; but this lacks consistency and may be variable. [...] Read more.
Rapid identification of possible vascular compromise in free flap reconstruction to minimize time to reoperation improves achieving free flap salvage. Subjective clinical assessment, often complemented with handheld Doppler, is the golden standard for flap monitoring; but this lacks consistency and may be variable. Non-invasive optical methods such as near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) could facilitate objective flap monitoring. A systematic review was conducted to compare NIRS with HSI in detecting vascular compromise in reconstructive flap surgery as compared to standard monitoring. A literature search was performed using PubMed and Embase scientific database in August 2021. Studies were selected by two independent reviewers. Sixteen NIRS and five HSI studies were included. In total, 3662 flap procedures were carried out in 1970 patients using NIRS. Simultaneously; 90 flaps were performed in 90 patients using HSI. HSI and NIRS flap survival were 92.5% (95% CI: 83.3–96.8) and 99.2% (95% CI: 97.8–99.7). Statistically significant differences were observed in flap survival (p = 0.02); flaps returned to OR (p = 0.04); salvage rate (p < 0.01) and partial flap loss rate (p < 0.01). However, no statistically significant difference was observed concerning flaps with vascular crisis (p = 0.39). NIRS and HSI have proven to be reliable; accurate and user-friendly monitoring methods. However, based on the currently available literature, no firm conclusions can be drawn concerning non-invasive monitoring technique superiority Full article
(This article belongs to the Special Issue Recent Advances and Applications of Image-Guided Surgery)
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