Chapter 2 Abstract Introduction Safety and efficiency are important topics in minimally invasive surgery. Apart from its advantages, laparoscopic surgery has some drawbacks. These consist of 2D‐imaging, challenging eye‐hand coordination and absence of tactile feedback. Enhanced imaging with earlier and clearer identification of essential tissue types can overcome part of these disadvantages. Research groups worldwide are investigating new technologies for image‐guided surgery purposes. This review article gives an overview of current developments in surgical optical imaging for improved anatomical identification and physiological tissue characterization during laparoscopic gastrointestinal surgery. Methods A systematic literature search in the PubMed database was conducted. Eligible studies reported on any kind of novel optical imaging technique applied for anatomical identification or physiological tissue characterization in laparoscopic gastrointestinal surgery. Gynecologic and urologic procedures were also included, whenever vascular, nerve, ureter or lymph node imaging was concerned. Results Various surgical imaging techniques were identified for enhanced intraoperative visualization of essential tissue types (i.e. blood vessel, bile duct, ureter, nerve, lymph node) and for tissue characterization purposes, such as assessment of blood perfusion. An overview is given of both preclinical and clinical experiences and the potential added value for intraoperative anatomical localization and characterization during laparoscopy. Conclusion Implementation of new optical imaging methods during laparoscopic gastrointestinal surgery can improve intraoperative anatomy navigation. This may lead to increased patient safety (preventing iatrogenic functional tissue injury) and procedural efficiency (shorter operating time). Near‐infrared fluorescence imaging seems to possess the greatest potential for implementation in clinical practice in the near future. 18
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