TY - JOUR
T1 - Assessing the development status of intraoperative fluorescence imaging for perfusion assessments, using the IDEAL framework
AU - Ishizawa, Takeaki
AU - McCulloch, Peter
AU - Muehrcke, Derek
AU - Carus, Thomas
AU - Wiesel, Ory
AU - Dapri, Giovanni
AU - Schneider-Koriath, Sylke
AU - Wexner, Steven D
AU - Abu-Gazala, Mahmoud
AU - Boni, Luigi
AU - Cassinotti, Elisa
AU - Sabbagh, Charles
AU - Cahill, Ronan
AU - Ris, Frederic
AU - Carvello, Michele
AU - Spinelli, Antonino
AU - Vibert, Eric
AU - Terasawa, Muga
AU - Takao, Mikiya
AU - Hasegawa, Kiyoshi
AU - Schols, Rutger M
AU - Pruimboom, Tim
AU - Murai, Yasuo
AU - Matano, Fumihiro
AU - Bouvet, Michael
AU - Diana, Michele
AU - Kokudo, Norihiro
AU - Dip, Fernando
AU - White, Kevin
AU - Rosenthal, Raul J
N1 - Funding Information:
The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Publisher Copyright:
© 2021, BMJ Publishing Group Ltd. All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - Objectives: Intraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: assessing tissue perfusion; identifying/localizing cancer; mapping lymphatic systems; and visualizing anatomy. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging for perfusion assessments using the Idea, Development, Exploration, Assessment, Long Term Study (IDEAL) framework, which was designed for describing the stages of innovation in surgery and other interventional procedures.Design: Narrative literature review with analysis of IDEAL stage of each field of study.Setting: All publications on intraoperative fluorescence imaging for perfusion assessments reported in PubMed through 2019 were identified for six surgical procedures: coronary artery bypass grafting (CABG), upper gastrointestinal (GI) surgery, colorectal surgery, solid organ transplantation, reconstructive surgery, and cerebral aneurysm surgery.Main outcome measures: The IDEAL stage of research evidence was determined for each specialty field using a previously described approach.Results: 196 articles (15 003 cases) were selected for analysis. Current status of research evidence was determined to be IDEAL Stage 2a for upper GI and transplantation surgery, IDEAL 2b for CABG, colorectal and cerebral aneurysm surgery, and IDEAL Stage 3 for reconstructive surgery. Using the technique resulted in a high (up to 50%) rate of revisions among surgical procedures, but its efficacy improving postoperative outcomes has not yet been demonstrated by randomized controlled trials in any discipline. Only one possible adverse reaction to intravenous indocyanine green was reported.Conclusions: Using fluorescence imaging intraoperatively to assess perfusion is feasible and appears useful for surgical decision making across a range of disciplines. Identifying the IDEAL stage of current research knowledge aids in planning further studies to establish the potential for patient benefit.
AB - Objectives: Intraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: assessing tissue perfusion; identifying/localizing cancer; mapping lymphatic systems; and visualizing anatomy. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging for perfusion assessments using the Idea, Development, Exploration, Assessment, Long Term Study (IDEAL) framework, which was designed for describing the stages of innovation in surgery and other interventional procedures.Design: Narrative literature review with analysis of IDEAL stage of each field of study.Setting: All publications on intraoperative fluorescence imaging for perfusion assessments reported in PubMed through 2019 were identified for six surgical procedures: coronary artery bypass grafting (CABG), upper gastrointestinal (GI) surgery, colorectal surgery, solid organ transplantation, reconstructive surgery, and cerebral aneurysm surgery.Main outcome measures: The IDEAL stage of research evidence was determined for each specialty field using a previously described approach.Results: 196 articles (15 003 cases) were selected for analysis. Current status of research evidence was determined to be IDEAL Stage 2a for upper GI and transplantation surgery, IDEAL 2b for CABG, colorectal and cerebral aneurysm surgery, and IDEAL Stage 3 for reconstructive surgery. Using the technique resulted in a high (up to 50%) rate of revisions among surgical procedures, but its efficacy improving postoperative outcomes has not yet been demonstrated by randomized controlled trials in any discipline. Only one possible adverse reaction to intravenous indocyanine green was reported.Conclusions: Using fluorescence imaging intraoperatively to assess perfusion is feasible and appears useful for surgical decision making across a range of disciplines. Identifying the IDEAL stage of current research knowledge aids in planning further studies to establish the potential for patient benefit.
U2 - 10.1136/bmjsit-2021-000088
DO - 10.1136/bmjsit-2021-000088
M3 - Article
C2 - 35047805
SN - 2631-4940
VL - 3
JO - BMJ Surgery, Interventions, & Health Technologies
JF - BMJ Surgery, Interventions, & Health Technologies
IS - 1
M1 - e000088
ER -