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

Irene Paraboschi, Paolo De Coppi, Danail Stoyanov, John Anderson, Stefano Giuliani

Journal: Journal of pediatric surgery 2021;56(4):655-662

PMID: 32900510

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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.

Address: Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK; Stem Cells & Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK; Cancer Section, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK. Electronic address: [email protected].; Stem Cells & Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.; Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK.; Cancer Section, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England, UK.; Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK; Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.

DOI: 10.1016/j.jpedsurg.2020.08.004