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Aportaciones de la fluorescencia a la cirugía endocrina
摘要： The use of fluorescence in surgery has expanded and become widespread in recent years, which has led to a real technological phenomenon with the emergence of devices adapted for use in laparoscopic and robotic approaches. Fluorescence-guided surgery in the field of endocrine surgery is also on the rise. More and more articles describe its use in surgery of the thyroid, parathyroid and adrenal glands, although the series are still modest in size and protocols have not been standardized. There are currently several developing areas for the application of fluorescence in endocrine surgery, including the use of fluorescence with indocyanine green in adrenal gland surgery, the identification and prediction of parathyroid perfusion with indocyanine green, and autofluorescence of the parathyroid glands. The objective of this article is to review the current applications of fluorescence in endocrine surgery.
关键词： Thyroid surgery,Parathyroid surgery,Indocyanine green,Endocrine surgery,Fluorescence-guided surgery,Adrenal surgery,Autofluorescence
更新于2025-09-23 15:23:52
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5-aminolevulinic acid induced protoporphyrin IX (ALA-PpIX) fluorescence guidance in meningioma surgery
摘要： Introduction 5-aminolevulinic acid induced protoporphyrin IX (5-ALA-PpIX) fluorescence guidance has emerged as a valuable surgical adjunct for resection of intracranial tumors. Methods Here we present a focused review on 5-ALA-PpIX fluorescence guidance for meningiomas. Results We discuss the clinical studies and specific applications to date as well as the two main intraoperative fluorescence technologies applied to meningiomas. Conclusions The use of 5-ALA-PpIX in meningiomas holds promising potential so neurosurgeons can improve surgical outcomes for patients with meningiomas as well as be pioneers in developing improved fluorescence imaging technologies.
关键词： Meningioma,Quantitative fluorescence,5-Aminolevulinic acid,Fluorescence-guided surgery,Protoporphyrin IX,Spectroscopy
更新于2025-09-23 15:23:52
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Indocyanine green fluorescencea??guided robotic left colectomy with stapled colorectal anastomosis a?? a videoa??vignette
摘要： Technical advances, such as indocyanine green-fluorescence angiography (ICG-FA), can contribute to minimize the occurrence of anastomotic leakage. We describe the case of a 53-year-old female patient presenting with abdominal pain and sideropaenic anemia. The colonoscopy showed an adenocarcinoma located in the sigmoid colon. Preoperative CT scan showed no sign of metastases. Surgery was planned according to Enhanced Recovery After Surgery program, and was carried out with da Vinci robot system Xi?. An extended medial-to-lateral approach was followed; the splenic flexure was mobilized by separating the superior surface of pancreas from the retroperitoneum and the lesser sac. Following the transection of the rectum with a 45-mm EndoWrist? stapler, the colon was extracted through a 6-cm Pfannenstiel incision. After division of the mesentery and before sectioning, the proximal transection margin was identified by ICG-FA. Then, the anvil of the EEA stapler was inserted and secured with a purse string. The colorectal end-to-end anastomosis was performed and the blood supply of the intestinal tissue was rechecked with ICG-FA. The postoperative period was uneventful and the patient was discharged after 3 days. Pathology report confirmed pT3N0 adenocarcinoma (0/22 node+). The present video demonstrates the usefulness of advanced surgical techniques for oncological left colectomy performed successfully with an extended medial-to-lateral approach associated with the use of ICG-FA. Randomized controlled trials are awaited to assess the effectiveness of the routine use of ICG-FA.
关键词： Robotic left colectomy,colon cancer,fluorescence-guided surgery,indocyanine green,colorectal anastomosis
更新于2025-09-23 15:19:57
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Fluorescence-Guided Neurosurgery (Neuro-oncology and Cerebrovascular Applications) || 1 Current Fluorescence-Guided Neurosurgery and Moving Forward
摘要： This introductory chapter provides a current overview of fluorescence-guided neurosurgery and includes future directions. The concepts of fluorescence and fluorescence-guided surgery (FGS) are introduced. Currently used fluorescent contrast agents in patients are summarized, including 5-aminolevulinic acid (5-ALA), fluorescein, and indocyanine green. Excitation light sources are discussed for each fluorescent contrast agent. Targeted fluorophores under clinical development for FGS are also introduced. Future directions in fluorescence-guided neurosurgery including handheld devices to better detect tumor fluorescence, dual fluorophore imaging, metabolic imaging in combination with FGS, and detection of the tumor margin will be discussed.
关键词： near-infrared imaging,fluorophore,indocyanine green,fluorescence-guided neurosurgery,fluorescence,operative microscope,fluorescence-guided surgery,fluorescein sodium,5-ALA
更新于2025-09-19 17:15:36
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The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer
摘要： Although surgical resection has been the primary treatment modality of solid tumors for decades, surgeons still rely on visual cues and palpation to delineate healthy from cancerous tissue. This may contribute to the high rate (up to 30%) of positive margins in head and neck cancer resections. Margin status in these patients is the most important prognostic factor for overall survival. In addition, second primary lesions may be present at the time of surgery. Although often unnoticed by the medical team, these lesions can have significant survival ramifications. We hypothesize that real-time fluorescence imaging can enhance intraoperative decision-making by aiding the surgeon in detecting close or positive margins and visualizing unanticipated regions of primary disease. The purpose of this study was to assess the clinical utility of real-time fluorescence imaging for intraoperative decision-making. Methods: Head and neck cancer patients (n=14) scheduled for curative resection were enrolled in a clinical trial evaluating panitumumab-IRDye800CW for surgical guidance (NCT02415881). Open-field fluorescence imaging was performed throughout the surgical procedure. The fluorescence signal was quantified as signal-to-background ratios to characterize the fluorescence contrast of regions of interest relative to background. Results: Fluorescence imaging was able to improve surgical decision-making in three cases (21.4%); identification of a close margin (n=1) and unanticipated regions of primary disease (n=2). Conclusion: This study demonstrates the clinical applications of fluorescence imaging on intraoperative decision-making. This information is required for designing phase III clinical trials using this technique. Furthermore, this study is the first to demonstrate this application for intraoperative decision-making during resection of primary tumors.
关键词： real-time intraoperative imaging,head and neck cancer,Fluorescence-guided surgery
更新于2025-09-19 17:15:36
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Use of optical fluorescence agents during surgery for pituitary adenomas: current state of the field
摘要： Introduction Differentiation of normal pituitary from abnormal tumor tissue remains a surgical challenge despite improvements in optical visualization technology for pituitary adenoma (PA) surgery. During neurosurgical procedures for other tumor types, 5-aminolevulinic acid (5-ALA) has become a focus of investigation based on its high specificity in differentiating tumor tissue. However, the role of 5-ALA and other optical fluorescent agents in PA surgery remains less clear. Objective To perform a systematic review on the use of various optical fluorescent agents in PA surgery. Method Using PRISMA guidelines, a systematic literature review to identify reports describing 5-ALA and other optical agents for fluorescence-guided surgery for PA was performed. Eleven research studies met inclusion criteria and were reviewed. Results In two studies, 5-ALA was not shown to be effective in aiding PA resection using standard neurosurgical endoscopic/microscopic approaches. 5-ALA photodynamic therapy was evaluated in two in-vitro models with inconsistent results. Intraoperative use of indocyanine green (ICG) concluded with varying results, but showed a tendency towards improved differentiation of functional PA. OTL38 showed potential for intraoperative identification of nonfunctioning PA, particularly in tumors with high folate receptor expression. One study reported clinically useful fluorescence following sodium fluorescein administration. Conclusion We conclude that selected optical fluorescent agents, including ICG and folate receptors, are most likely to hold promise for clinical use in differentiating PA from normal tissue.
关键词： Pituitary adenoma,Fluorescence guided surgery,Optical fluorescence agents,5-Aminolevulinic acid
更新于2025-09-04 15:30:14
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The application of fluorescence techniques in meningioma surgery—a review
摘要： Surgical resections of meningiomas, the most common intracranial tumor in adults, can only be curative if radical resection is achieved. Potentially, the extent of resection could be improved, especially in complex and/or high-grade meningiomas by fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA), indocyanine green (ICG), or fluorescein. This review aims to summarize and evaluate these fluorescence-guided meningioma surgery techniques. PubMed and Embase were searched for relevant articles. Additionally, we checked reference lists for further studies. Forty-eight articles were included in the final analysis. 5-ALA fluoresced with varying sensitivity and selectivity in meningiomas and in invaded bone and dura mater. Although ICG was mainly applied for video angiography, one report shows tumor fluorescence 18–28 h post-ICG injection. Lastly, the use of fluorescein could aid in the identification of tumor remnants; however, detection of dural tail is highly questionable. Fluorescence-guided meningioma surgery should be a reliable, highly specific, and sensitive technique. Despite numerous studies reporting the use of fluorescent dyes, currently, there is no evidence that these tools improve the radical resection rate and long-term recurrence-free outcome in meningioma surgery without neurological deficits. Evidence regarding the effectiveness and increased safety of resection after the application of these fluorophores is currently lacking. Future research should focus on the development of a meningioma-targeted, highly sensitive, and specific fluorophore.
关键词： Fluorescence-guided surgery,Meningioma,Indocyanine green,5-Aminolevulinic acid,Intraoperative imaging,Fluorescein
更新于2025-09-04 15:30:14
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Fluorescence-Guided Cancer Diagnosis and Surgery by a Zero Cross-Talk Ratiometric Near-Infrared γ-Glutamytranspeptidase Fluorescent Probe
摘要： The ability to early detect cancer in an accurate and rapid fashion is of critical importance for cancer diagnosis and accurate resection in surgery. γ-Glutamyltranspeptidase (GGT) is overexpressed in several human cancers while keeps low expression in normal microenvironment, and thus recognized as an important cancer biomarker. To date, rational design of a zero cross-talk ratiometric near-infrared (NIR) GGT fluorescent probe for efficiently cancer diagnosis in various biological samples is still a big challenge. In this work, a zero cross-talk ratiometric NIR GGT fluorescent probe named Cy-GSH is developed. Cy-GSH shows highly sensitive to GGT, which is desired for cancer early diagnosis. Upon additional GGT, a large emission shift from 805 nm to 640 nm is observed, which is suitable for visualizing deeply located cancer in vivo. In addition, successful monitoring GGT activity in bloods, cells, tissues and in vivo, makes Cy-GSH possess great potentials for the clinical cancer early diagnosis. Furthermore, accurate visualizing tumors and metastases in mouse models illuminates that the probe may be a convenient tool for fluorescence-guided cancer surgery. To our knowledge, this is the first report to describe the strategy of a zero cross-talk ratiometric NIR GGT fluorescent probe for cancer early diagnosis and fluorescence-guided surgery.
关键词： fluorescent probe,γ-Glutamyltranspeptidase,GGT,cancer diagnosis,fluorescence-guided surgery
更新于2025-09-04 15:30:14