Future Directions in Fluorescence-and Image-Guided Surgery

Fluorescence- and image-guided surgery are rapidly evolving fields that aim to bridge the gap between preoperative imaging and the intraoperative environment to improve surgical outcomes. Developments in novel molecular fluorophores, laser speckle contrast imaging, and augmented reality show promise in clinical adoption. Fluorescence guidance systems have been used in various clinical applications, including tumor localization, anatomy identification, perfusion assessment, and lymphatic mapping using fluorophores such as indocyanine green. Recent development of novel molecular and activatable fluorophores offers the potential for more specific lesion location and assessment of complete resection. Laser speckle contrast imaging (LSCI) is a noninvasive, real-time imaging technique with validation studies that suggest that it is a potentially valuable tool for perfusion assessment in surgery. Augmented reality is another technology that is increasingly useful in image-guided surgery which can aid surgeons in the rapid identification of subsurface targets and structures, reduce cognitive load, and guide resections by overlaying a virtual model onto the patient. The development of targeted molecular fluorophores, laser speckle contrast imaging, and augmented reality has the potential to improve surgical outcomes by providing more accurate and efficient image guidance during surgery. Ongoing research in these areas will lead to further advancements to enable expanded clinical applications.