Fluorescence imaging in pediatric surgery: State-of-the-art and future perspectives

Abstract

Background: The employment of fluorescence imaging has gained popularity in many fields of adult surgery where it has demonstrated great potentials to improve both surgical and oncological outcomes while minimizing anesthetic time and lowering health-care costs. However, the clinical application of fluorescence-guided surgery (FGS) in pediatrics is just at the initial phase.

Material and methods: A systematic review of current clinical uses of FGS in pediatric surgery was performed along with a discussion on its advantages, limitations and future developments.

Results: 21 studies were included: 9 retrospective and 1 prospective study, 8 case reports, 2 case series and a review article reporting authors' institutional experience. Great emphasis was given to surgical resection of hepatoblastoma and its metastasis (n = 6), real-time imaging of the biliary tree (n = 3) and urogenital system (n = 2). Other current uses concern the assessment of blood perfusion (intestine, n = 3; myocutaneous flap, n = 1; transplanted liver, n = 1) and lymphatic flow imaging (n = 4).

Conclusion: Despite a paucity of clinical studies evaluating its role in pediatric surgery, FGS has shown promising results in helping guide tumor resection and improving the accuracy of anatomical delineation.

Type of study: Review article.

Level of confidence: Level IV.

Keywords: Fluorescein sodium; Fluorescence imaging; Fluorescence-guided surgery; Indocyanine green; Near-infrared dyes.