Advanced intraoperative imaging methods for laparoscopic anatomy navigation 19 Introduction The laparoscopic operation technique has allowed surgeons to conduct traditional open surgical procedures in a minimally invasive way. Benefits of laparoscopy to the patient have been shown in terms of reduced postoperative pain, increased postoperative comfort, lower risk of wound infection, shorter hospital stay and a quicker return to normal physical activities1,2. A limited field of view, 2D‐imaging, different eye‐hand coordination and the inability to achieve tactile feedback are limitations of laparoscopic surgery. Yet the laparoscopic technique is widely applied nowadays. Increasing attention is arising in society for the safety of laparoscopic surgery. The Dutch Health Care Inspectorate has drawn attention to this in its report, “Risks of minimally invasive surgery underestimated”, of November 20073. Besides safety for the patient, procedural efficiency is a constant point of concern in modern healthcare. Specially organized surgery programs are designed for inguinal hernia and gallbladder operations to improve efficiency and safety, and to save money. Colorectal surgery is the latest form of high‐volume surgery, in which the laparoscopic technique has now widely been introduced. It is an advanced procedure that requires a high level of skills in endoscopic surgery. Differentiating specific anatomical structures requires time and risks are involved in this process. Vascular injury, ureter lesion, bile duct injury and nerve damage are complications that may occur during laparoscopic gastrointestinal surgery due to anatomical misinterpretation. Earlier and clearer identification of critical structures (i.e. blood vessel, bile duct, ureter, nerve, lymph node) might help to prevent these injuries. New optical imaging techniques for real‐time enhanced surgical guidance have emerged and are subject of research worldwide. The implementation of intraoperative imaging methods could be of great assistance to the (inexperienced) surgeon and it could help to improve the safety and efficiency of laparoscopic high‐volume surgery. The aim of this article is to give an overview of the latest developments in optical imaging techniques for enhanced anatomical identification and physiological characterization during laparoscopic gastrointestinal surgery. Methods A systematic literature search was performed using the PubMed database. The following generic terms were applied: ‘laparoscopic surgery’, ‘optical imaging techniques’, ‘anatomy identification’ and ‘tissue characterization’. See Supplement for a detailed search strategy.
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