This paper presents a surgical optical navigation system with non-invasive, real-time, and positioning characteristics for open surgical procedure. The design was based on the principle of near-infrared fluorescence molecular imaging. The in vivo fluorescence excitation technology, multi-channel spectral camera technology and image fusion software technology were used. Visible and near-infrared light ring LED excitation source, multi-channel band pass filters, spectral camera 2 CCD optical sensor technology and computer systems were integrated, and, as a result, a new surgical optical navigation system was successfully developed. When the near-infrared fluorescence was injected, the system could display anatomical images of the tissue surface and near-infrared fluorescent functional images of surgical field simultaneously. The system can identify the lymphatic vessels, lymph node, tumor edge which doctor cannot find out with naked eye intra-operatively. Our research will guide effectively the surgeon to remove the tumor tissue to improve significantly the success rate of surgery. The technologies have obtained a national patent, with patent No. ZI.2011 1 0292374.1.
Objective The aim of this article is to verify the clinical effect of the near-infrared fluorescent liver cancer surgery projection navigation system without display screen. Methods Three patients who need to undergo open hepatectomy for liver cancer in the Affiliated Hospital of Southwest Medical University from March 2021 to May 2021 were included, verifying the accuracy, stability, and time delay effect of the self-developed near-infrared fluorescence projection navigation system for the location of tumor in surgeries. Results The intraoperative tumor location could be accurately displayed by the near-infrared fluorescence projection system and there was no significant difference between the location of the tumor displayed by intraoperative ultrasound. The tumor location displayed by the near-infrared fluorescence projection system was not influenced by the tumor movement and had no visual-time delay. Postoperative pathology confirmed that the projection range was consistent with the tumor range. Conclusion This near-infrared fluorescence projection technology innovates the intraoperative tumor imaging mode and can accurately navigate open hepatectomy in small sample trials, and it is expected to achieve wide clinical application through subsequent iterative optimization and verification.
ObjectiveTo explore the clinical application of near-infrared autofluorescence (NIRAF) detection technology in protecting the parathyroid glands and the research progress on the autofluorescent substances. MethodThe recent literature on clinical application of NIRAF detection technology in protecting the parathyroid glands and the identification of fluorescent substances, both domestically and internationally, was conducted. ResultsThe majority of current studies indicate that NIRAF detection technology can effectively assist surgeons in identifying parathyroid tissue, improve the accuracy of intraoperative parathyroid identification, and reduce postoperative complications such as hypocalcemia. However, a small number of studies have found that the use of NIRAF detection technology during surgery does not significantly reduce postoperative complications in thyroid surgery patients, especially in those with secondary hyperparathyroidism. Current research on autofluorescent substances in the parathyroid glands remains relatively limited, with proteins such as the calcium-sensing receptor and vitamin D receptor being considered potential sources of fluorescence emitted by the parathyroid glands under near-infrared light excitation. ConclusionsBased on the reviewed literature, NIRAF detection technology for parathyroid gland identification has demonstrated significant effectiveness in intraoperative identification of parathyroid tissue and reduction of postoperative complications. However, limitations such as insufficient accuracy in patients with hyperparathyroidism and lack of user-friendliness restrict its clinical application. Therefore, future research should focus on identifying the endogenous fluorescent substances in the parathyroid glands and their luminescence mechanisms. This will enable targeted improvements in fluorescence detection technology, further enhancing the accuracy and convenience of intraoperative parathyroid detection, ultimately benefiting patients more significantly.
Objective To explore the feasibility of using high-definition thoracoscopy to identify sympathetic ganglia during thoracic sympathicotomy for primary palmar hyperhidrosis. MethodsThe clinical data of patients with primary palmar hyperhidrosis who underwent high-definition thoracoscopic sympathicotomy in Taikang Xianlin Drum Tower Hospital from June to July 2023 were retrospectively analyzed. Intraoperative visualization rates and anatomical variations of sympathetic ganglia were recorded, and the consistency between white-light thoracoscopy and near-infrared fluorescence imaging was compared. Additionally, surgical videos from previous fluorescence-guided procedures were reviewed. Results Finally 100 patients were collected, including 54 females and 46 males, with an average age of (21.92±6.56) years. All patients underwent endoscopic thoracic sympathicotomy at R3 level. The overall intraoperative ganglion visualization rate was 92.5% (740/800), with G2-G5 rates of 95.5% (191/200), 94.0% (188/200), 94.0% (188/200), and 86.5% (173/200), respectively. Ganglion variations occurred in 32.0% (237/740), predominantly at G3 (29.8%) and G4 (42.6%). In 5 indocyanine green-enhanced patients, the concordance rate between white-light and near-infrared fluorescence imaging was 100.0% (38/38). Video analysis of 14 near-infrared fluorescence-guided surgeries demonstrated a 99.1% (107/108) consistency rate. Postoperative palmar hyperhidrosis improvement reached 100.0% (100/100) with no Horner’s syndrome. Conclusion With the wide clinical application of high-definition thoracoscopy, accurate thoracic sympathicotomy has the feasibility of clinical application.
ObjectiveTo evaluate the short-term outcomes of near-infrared fluorescence imaging (NIRF) technique in minimally invasive McKeown esophagectomy for esophageal cancer. MethodsPatients who consecutively underwent minimally invasive McKeown esophagectomy for esophageal cancer performed by a single surgical team in the Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, between July 2020 and December 2023 were included. Patients were categorized into an NIRF group and a control group based on whether NIRF was employed to assess gastric conduit blood flow. We compared the clinical characteristics, operative parameters, major postoperative complications, and short-term quality of life between the two groups. ResultsA total of 246 patients were included. The NIRF group comprised 132 patients (85 males, 47 females) with a mean age (62.6±6.7) years, and the control group included 114 patients (78 males, 36 females) with a mean age (64.4±3.8) years. There were no significant differences in operative time, intraoperative blood loss, number of harvested lymph nodes, or hospital stay between the two groups (P>0.05). Similarly, the rates of recurrent laryngeal nerve injury or cardiopulmonary complications did not differ significantly between the groups (P>0.05). No chylothorax or 90-day mortality occurred in either group. Anastomotic leakage occurred in 5 (3.79%) patients in the NIRF group and 9 (7.89%) patients in the control group. The difference in anastomotic leakage rates was not statistically significant (P=0.098), showing only a trend towards a lower incidence in the NIRF group. Receiver operating characteristic curve analysis indicated that maximum fluorescence intensity (MFI) was correlated with gastric conduit perfusion, with an MFI of 20.5 identified as the cutoff value for predicting anastomotic leakage (P=0.039). Further analysis showed that in the NIRF group, an indocyanine green fluorescence imaging time >95 s and a blood flow velocity <1.7 cm/s were significantly associated with an increased risk of anastomotic leakage (P<0.05). The SF-36 quality of life score at 3 months postoperatively was significantly better in the NIRF group than in the control group (P<0.001); however, there was no significant difference in scores between the two groups at 12 months postoperatively (P=0.704). Conclusion In minimally invasive esophagectomy for esophageal cancer, NIRF can effectively assess gastric conduit blood perfusion using quantitative parameters, demonstrates a trend towards reducing anastomotic leakage rates, and contributes to accelerated early postoperative recovery and improved short-term quality of life.
