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 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.
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.
ObjectiveTo investigate the short-term outcomes and quality of life (QoL) in patients undergoing minimally invasive McKeown esophagectomy with the assistance of near-infrared fluorescence imaging (NIRF). MethodsThis retrospective study included consecutive patients who underwent minimally invasive McKeown esophagectomy performed by a single surgical team at the Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, between July 2020 and December 2023. Patients were divided into two groups based on whether NIRF was used to assess gastric conduit perfusion: a NIRF group and a control group. Clinical characteristics, perioperative data, major postoperative complications, and short-term QoL were compared between the two groups. ResultsA total of 246 patients were included. The NIRF group comprised 132 patients, including 85 males and 47 females with a mean age of (62.6±6.7) years, and the control group consisted of 114 patients, including 78 males and 36 females with a mean age of (64.4±3.8) years. No significant differences were observed between the two groups in terms of operative time, intraoperative blood loss, number of dissected lymph nodes, or length of hospital stay (all P>0.05). There were also no significant differences in the rates of recurrent laryngeal nerve injury, cardiopulmonary complications, chylothorax, and 90-day mortality (all P>0.05). The incidence of anastomotic leakage was 3.78% in the NIRF group, lower than the 7.89% in the control group. Receiver operating characteristic (ROC) curve analysis, generated from software-assisted fluorescence intensity data, indicated that maximum fluorescence intensity (MFI) was associated with gastric conduit perfusion. An MFI of 20.5 was determined as the optimal cut-off value for predicting anastomotic leakage (P<0.05). Further analysis within the NIRF group showed that a fluorescence appearance time >95 s and a flow velocity <1.7 cm/s were significantly associated with an increased risk of anastomotic leakage (P<0.05). Regarding QoL, the SF-36 scores at 3 months postoperatively were significantly better in the NIRF group than in the control group (P<0.001). However, no significant difference was observed between the two groups at 12 months postoperatively (P=0.704). Conclusion The use of NIRF during minimally invasive esophagectomy provides an effective method for assessing gastric conduit perfusion via quantitative parameters. It significantly reduces the incidence of anastomotic leakage, thereby accelerating early postoperative recovery and improving short-term QoL.
