Scientific article
Open access

Assessing the development status of intraoperative fluorescence imaging for perfusion assessments, using the IDEAL framework

Published inBMJ surgery, interventions, & health technologies, vol. 3, no. 1, e000088
Publication date2021-10-19
First online date2021

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.

  • Development study
  • Device evaluation
  • Health technology
Citation (ISO format)
ISHIZAWA, Takeaki et al. Assessing the development status of intraoperative fluorescence imaging for perfusion assessments, using the IDEAL framework. In: BMJ surgery, interventions, & health technologies, 2021, vol. 3, n° 1, p. e000088. doi: 10.1136/bmjsit-2021-000088
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Article (Published version)
ISSN of the journal2631-4940

Technical informations

Creation01/27/2022 9:48:00 AM
First validation01/27/2022 9:48:00 AM
Update time03/16/2023 6:31:27 AM
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