A narrative review of fluorescence imaging in robotic-assisted surgery

OBJECTIVE: In this review, we provide examples of applications of fluorescence imaging in urologic, gynecologic, general, and endocrine surgeries. BACKGROUND: While robotic-assisted surgery has helped increase the availability of minimally invasive procedures across surgical specialties, there remains an opportunity to reduce adverse events associated with open, laparoscopic, and robotic-assisted methods. In 2011, fluorescence imaging was introduced as an option to the da Vinci Surgical System, and has been standard equipment since 2014. Without interfering with surgical workflow, this fluorescence technology named Firefly(®) allows for acquisition and display of near-infrared fluorescent signals that are co-registered with white light endoscopic images. As a result, robotic surgeons of all specialties have been able to explore the clinical utility of fluorescence guided surgery. METHODS: Literature searches were performed using the PubMed and MEDLINE databases using the keywords “robotic-assisted fluorescence surgery”, “ICG robotic surgery”, and “fluorescence guided surgery” covering the years 2011–2020. CONCLUSIONS: Real-time intraoperative fluorescence guidance has shown great potential in helping guide surgeons in both simple and complex surgical interventions. Indocyanine green is one of the most widely-used imaging agents in fluorescence guided surgery, and other targeted, near-infrared imaging agents are in various stages of development. Fluorescence is becoming a reliable tool that can help surgeons in their decision-making process in some specialties, while explorations continue in others.