What is Fluorescence Guided Surgery?

Fluorescence Guided Surgery (FGS) is a medical imaging technique that uses fluorescent dye to identify anatomic structures during surgical procedures. FGS typically involves three components:

1. Fluorescent Dye: The most commonly used fluorescent agent is Indocyanine Green (IGC). ICG has been approved by the FDA in 1959 and has demonstrated to be safe and can be used in different surgical applications. 

2. An Excitation Source:The ICG is illuinated with a specific light source that causes the dye to glow. This enhances the structure in which the surgeon needs to see. 

What are the advantages of Fluorescence Guided Surgery?

Despite many advances in preoperative medical imaging such as CT and MRI scans, surgeons still almost exclusively operate under white (visible) light during their procedures and must rely on their ability to see and feel target tissues. Unfortunately, most human tissue looks very similar under white light, and it can be very difficult to distinguish one tissue from another or to completely remove a target tissue such as a tumor. In addition, a surgeon can only see the topmost layer of tissue under white light while tissues and structures underneath will remain hidden.

FGS essentially gives the surgeon the ability to ‘see’ in a different wavelength of light that would otherwise be invisible to them. By combining this visual ability with the special dyes that glow in those wavelengths surgeons can much more precisely target or avoid certain organs or tissues. In addition, the near-infrared light used in FGS can more easily penetrate human tissues, allowing surgeons to see ‘through’ layers of tissue and organs.

In addition to allowing a surgeon to see what otherwise would be invisible, FGS has the added advantage of being a real-time imaging process. Whereas traditional imaging like X-Rays, CT Scans, and MRI scans can provide excellent images, they are all limited to providing static images.

Think of FGS as being the equivalent of giving a surgeon GPS whereas before they were working with only a map!

How is FGS Currently Being Used?

This table from this article outlines the current clinical and preclinical fluorescence-guided surgery techniques:

Application Types  
Sentinel lymph node mapping Breast cancer  
 
  Melanoma  
  Head and neck cancer  
  Lung cancer  
  Esophagus cancer  
  Gastric cancer  
  Colorectal cancer  
  Anal cancer  
  Prostate cancer  
  Penile cancer  
Lymphography Lymph flow  
Angiography Cerebral aneurysm  
  Coronary artery bypass grafting  
  Abdominal aortic aneurysm  
  Abdominal surgery  
  Reconstructive surgery  
Anatomic imaging Cholangiography  
  Pancreas  
 
  Ureters  
  Nerves  
  Parathyroid and thyroid grands  
  Endocrine grands  
Tumor imaging Malignant glioma  
   
   
   
  Brain metastases  
  Head and neck cancer  
 
  Hepatocellular carcinoma  
  Liver metastases  
  Breast cancer  
     
     
     
     
  Lung and chest masses  
   
   
     
  Ovarian cancer  
     
     
     
     
  Pancreatic cancer  
     
  Insulinoma  
  Solitary fibrous tumor (pancreas)  
  Renal cell carcinoma  
     
  Bladder cancer  
  Prostate cancer  
     
  Gastric cancer  
  Colorectal cancer  
     
     
  Basal cell carcinoma  
     
  Sarcoma  
  Parathyroid adenoma  
Laparoscopic- and robotic-assisted surgeries Nephrectomy  
  Cholecystectomy  
  Esophagectomy  
  Gastrectomy  
  Adrenalectomy  
Fluorescence endoscopy Brain aneurysm  
  Endonasal surgery  
  Angiography  
  Brain tumor  
  Head and Neck tumor  
  Gastric cancer  
Marking tumor Colonic tattooing