Could fluorescence-guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary

N Vettoretto¹, E Foglia², L Ferrario², C Gerardi³, B Molteni⁴, U Nocco⁵, E Lettieri⁶, S Molfino⁴, G L Baiocchi⁴, U Elmore⁷, R Rosati⁷, G Currò⁸, E Cassinotti⁹, L Boni⁹, R Cirocchi¹⁰, A Marano¹¹, W L Petz¹², A Arezzo¹³, M A Bonino¹³, F Davini¹⁴, A Biondi¹⁵, G Anania¹⁶, F Agresta¹⁷, G Silecchia¹⁸

Affiliations

¹ Chirurgia Montichiari, Azienda Socio Sanitaria Territoriale Degli Spedali Civili, V.le Ciotti 154, Montichiari, 25018, Brescia, Italy. nereovet@gmail.com.
² LIUC - Università Cattaneo, Castellanza, VA, Italy.
³ Centro di Politiche Regolatorie, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milan, Italy.
⁴ Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy.
⁵ Ingegneria Clinica, Azienda Socio Sanitaria Territoriale dei Sette Laghi, Varese, Italy.
⁶ School of Management, Department of Management, Economics and Industrial Engineering, Politecnico, Milano, Italy.
⁷ Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
⁸ Department of Human Pathology of Adult and Evolutive Age, University Hospital of Messina, Messina, Italy.
⁹ Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy.
¹⁰ Department of Surgical Sciences, University of Perugia, Perugia, Italy.
¹¹ Chirurgia Generale ed Oncologica, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy.
¹² Chirurgia, IEO, European Institute of Oncology IRCCS, Milan, Italy.
¹³ Department of Surgical Sciences, University of Torino, Turin, Italy.
¹⁴ Centro multidisciplinare Chirurgia Robotica, Chirurgia Toracica mini-invasiva e Robotica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
¹⁵ Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
¹⁶ Chirurgia Generale, University of Ferrara, Ferrara, Italy.
¹⁷ Chirurgia Generale, Azienda ULSS 5 "Polesana", Hospital of Adria, Adria, RO, Italy.
¹⁸ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, Rome, Italy.

PMID: 32274626
DOI: 10.1007/s00464-020-07542-3

Could fluorescence-guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary

N Vettoretto et al. Surg Endosc. 2020 Jul.

. 2020 Jul;34(7):3270-3284.

doi: 10.1007/s00464-020-07542-3.

Authors

Affiliations

¹ Chirurgia Montichiari, Azienda Socio Sanitaria Territoriale Degli Spedali Civili, V.le Ciotti 154, Montichiari, 25018, Brescia, Italy. nereovet@gmail.com.
² LIUC - Università Cattaneo, Castellanza, VA, Italy.
³ Centro di Politiche Regolatorie, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milan, Italy.
⁴ Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy.
⁵ Ingegneria Clinica, Azienda Socio Sanitaria Territoriale dei Sette Laghi, Varese, Italy.
⁶ School of Management, Department of Management, Economics and Industrial Engineering, Politecnico, Milano, Italy.
⁷ Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
⁸ Department of Human Pathology of Adult and Evolutive Age, University Hospital of Messina, Messina, Italy.
⁹ Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy.
¹⁰ Department of Surgical Sciences, University of Perugia, Perugia, Italy.
¹¹ Chirurgia Generale ed Oncologica, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy.
¹² Chirurgia, IEO, European Institute of Oncology IRCCS, Milan, Italy.
¹³ Department of Surgical Sciences, University of Torino, Turin, Italy.
¹⁴ Centro multidisciplinare Chirurgia Robotica, Chirurgia Toracica mini-invasiva e Robotica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
¹⁵ Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
¹⁶ Chirurgia Generale, University of Ferrara, Ferrara, Italy.
¹⁷ Chirurgia Generale, Azienda ULSS 5 "Polesana", Hospital of Adria, Adria, RO, Italy.
¹⁸ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, Rome, Italy.

PMID: 32274626
DOI: 10.1007/s00464-020-07542-3

Abstract

Background: Indocyanine green fluorescence vision is an upcoming technology in surgery. It can be used in three ways: angiographic and biliary tree visualization and lymphatic spreading studies. The present paper shows the most outstanding results from an health technology assessment study design, conducted on fluorescence-guided compared with standard vision surgery.

Methods: A health technology assessment approach was implemented to investigate the economic, social, ethical, and organizational implications related to the adoption of the innovative fluorescence-guided view, with a focus on minimally invasive approach. With the support of a multidisciplinary team, qualitative and quantitative data were collected, by means of literature evidence, validated questionnaires and self-reported interviews, considering the dimensions resulting from the EUnetHTA Core Model.

Results: From a systematic search of literature, we retrieved the following studies: 6 on hepatic, 1 on pancreatic, 4 on biliary, 2 on bariatric, 4 on endocrine, 2 on thoracic, 11 on colorectal, 7 on urology, 11 on gynecology, 2 on gastric surgery. Fluorescence guide has shown advantages on the length of hospitalization particularly in colorectal surgery, with a reduction of the rate of leakages and re-do anastomoses, in spite of a slight increase in operating time, and is confirmed to be a safe, efficacious, and sustainable vision technology. Clinical applications are still presenting a low evidence in the literature.

Conclusion: The present paper, under the patronage of Italian Society of Endoscopic Surgery, based on an HTA approach, sustains the use of fluorescence-guided vision in minimally invasive surgery, in the fields of general, gynecologic, urologic, and thoracic surgery, as an efficient and economically sustainable technology.

Keywords: Fluorescence; Indocyanine green; Laparoscopy; Surgery.

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References

1. Vettoretto N (2018) Why laparoscopists may opt for three-dimensional view: a summary of the full HTA report on 3D versus 2D laparoscopy by S.I.C.E. (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie). Surg Endosc 32:2986–2993 - PubMed - PMC
1. Kamisaka K, Yatsuji Y, Yamada H, Kameda H (1974) The binding of indocyanine green and other organic anions to serum proteins in liver diseases. Clin Chim Acta 53:255 - PubMed
1. Alander J (2012) A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging. https://doi.org/10.1155/2012/940585 - DOI - PubMed - PMC
1. Mishra A (1990s) Cyanine during the 1990s: a review. Chem Rev 100(6):1973 - PubMed
1. Kang Y (2010) Dynamic fluorescence imaging of indocyanine green for reliable and sensitive diagnosis of peripheral vascular insufficiency. Microvasc Res 80:552 - PubMed

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Could fluorescence-guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary

Affiliations

Could fluorescence-guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical