Advanced intraoperative imaging methods for laparoscopic anatomy navigation approved for clinical use in humans. Other and more targeted fluorescent contrast agents are in development, but at the moment only for preclinical use. A few advanced imaging devices for application in minimally invasive surgery are already commercially available for clinical use. These systems either possess the ability of infrared ray imaging, NIR fluorescence imaging, or optical coherence tomography (optical probe for NOTES). The other imaging modalities mentioned in this overview are still in a more basic development phase. Hyperspectral imaging has been tested in a clinical setting. Incorporation of these and the other remaining imaging modalities in commercially available imaging devices is in slow progress. Looking at the outlined potential and remaining limitations of the advanced imaging techniques as discussed in this review, future research should mainly focus on optimization of laparoscopic systems for advanced intraoperative imaging. With respect to near‐infrared fluorescence laparoscopy (highlighted in Table 2.2), a technique which is probably closest to enter the clinical practice in the near future, optimizing the current laparoscopic imaging systems is needed to make them more easily applicable in the operating room. Current systems not yet possess the ability to display the fluorescence image in anatomical context, in other words: fluorescence image overlay on white light image is not yet possible. Furthermore, imaging depth at which the imaging system can detect a fluorophore needs improvement. To overcome this obstacle, also an increase in fluorescent capabilities of contrast agents is desirable. In fact, new more powerful fluorescent dyes (e.g. CW800‐CA) are expected to become available in the near future. 29 Conclusion The implementation of new intraoperative imaging modalities provides the surgeon with improved real‐time identification and physiological tissue characterization of essential anatomical structures encountered during laparoscopic gastrointestinal surgery. This could significantly contribute to intraoperative anatomy navigation and critical decision‐making, and may eventually lead to increased patient safety and procedural efficiency. Based on the findings in literature and the increasing knowledge of the described techniques, near‐infrared fluorescence imaging probably possesses the greatest potential for implementation in clinical practice in the near future.
proefschrift_Schols_SLV
To see the actual publication please follow the link above