General introduction 9 Background Patient safety and procedural efficiency are constant points of concern in modern health care. In surgery, this particularly accounts for minimally invasive surgery. The Dutch Health Care Inspectorate has drawn attention to safety in its report, “Risks of minimally invasive surgery underestimated”, of November 20071. To improve safety and efficiency, and to reduce costs, specially organized surgery programs are designed to conduct e.g. laparoscopic inguinal hernia, gallbladder and colorectal surgery in high‐volume. The laparoscopic operation technique has allowed surgeons to conduct traditional open surgical procedures in a minimally invasive way. Benefits of laparoscopy to the patient include reduced postoperative pain, increased postoperative comfort, reduced risk of wound infection, reduced hospital stay and a quicker return to normal physical activities2,3. Yet, in addition to its advantages, laparoscopic surgery also has some drawbacks. These consist of challenging eye‐hand coordination, absence of tactile feedback, small two‐dimensional field of view (in contrast to three‐dimensional human eye representation) thereby lacking orientation points that open surgery offers. Nevertheless the laparoscopic technique is widely applied nowadays. For all kinds of surgical procedures (open or laparoscopic) it is of great importance to distinguish vital anatomy, e.g. nerves, ureters, bile ducts and arteries. Discrimination of vital structures, when challenging, can impose increased risks with severe complications, such as vascular injury, ureter lesion, bile duct injury and nerve damage. An optical tool that can identify vital structures and enhance the contrast of these structures from surrounding fatty or connective tissues, or detect hidden structures (e.g. covered under a layer of fatty tissue) will offer preservation of these structures4. Innovative optical imaging and spectroscopy techniques enabling real‐time enhanced surgical guidance have emerged in the last decade and are subject of research worldwide5. Towards optical enhancement of anatomical landmarks in surgery Innovative optical techniques can offer a roadmap to improve intraoperative identification and characterization of tissues. This would be of great interest for surgery in general, but especially for minimally invasive procedures, when a surgeon lacks spatial perception from direct sight and haptic feedback from direct touch. Two of
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