Image-guided Surgery in Abdominal Procedures: A Systematic Review with Overview
DOI:
https://doi.org/10.36489/nursing.2025v30i329p11920-11946Keywords:
Image-guided surgery, Indocyanine green, Fluorescence, Intraoperative ultrasound, Minimally invasive surgery, Augmented realityAbstract
Introduction: The rapid evolution of optical and digital imaging technologies has transformed abdominal surgery,
establishing Image-Guided Surgery (IGS) as a high-precision tool for real-time intraoperative orientation. Indocyanine Green (ICG) fluorescence, intraoperative ultrasound (IOUS), fluorescent cholangiography (FC), multispectral imaging, and 3D/augmented reality (AR) systems have enhanced intraoperative safety, tissue perfusion assessment, and anatomic visualization in minimally invasive procedures. Methods: A systematized literature review was conducted according to PRISMA 2020 guidelines. Searches were performed in PubMed (2018–2025) using the terms “Image-Guided Surgery,” “Abdominal Surgery,” “Fluorescence Imaging,” “Indocyanine Green,” “Intraoperative Ultrasound,” and “Augmented Reality.” A total of 16 full-text articles in English involving human subjects and abdominal minimally invasive surgery were included. Editorials, letters, and isolated case reports were excluded. Results: ICG fluorescence was the most studied modality, achieving a
60–70% reduction in anastomotic leaks and >95% bile duct identification rate. IOUS detected up to 20% of additional
hepatic lesions, while fluorescent cholangiography reduced iatrogenic injuries by 30%. Emerging technologies such as NIR-II fluorescence, hyperspectral imaging, and 3D/AR navigation increased anatomical precision by 15–20%, optimizing operative outcomes. Conclusion: Image-guided surgery has become a cornerstone of modern abdominal surgery, enhancing precision, safety, and intraoperative decision-making. The convergence of fluorescence, ultrasound, 3D visualization, and artificial intelligence defines a new era of smart surgery, combining anatomical accuracy with predictive and data-driven intraoperative
performance.
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References
Avella, P., et al. (2025). Real-time navigation in liver surgery through indocyanine green fluorescence: An updated analysis of worldwide protocols and applications. Journal of Hepatobiliary Surgery. Recuperado de https://pmc.ncbi.nlm.nih.gov/articles/PMC11898688/
Borg, L., Portelli, M., Testa, L., & Andrejevic, P. (2025). The use of indocyanine green for colorectal anastomoses: A systematic review and meta-analysis. Annals of the Royal College of Surgeons of England, 107(6), 390–396. https://doi.org/10.1308/rcsann.2024.0002
Cassinotti, E., Al-Taher, M., Antoniou, S. A., Arezzo, A., Baldari, L., Boni, L., Bonino, M. A., Bouvy, N. D., Brodie, R., Carus, T., Chand, M., Diana, M., Eussen, M. M. M., Francis, N., Guida, A., Gontero, P., Haney, C. M., Jansen, M., Mintz, Y., Morales-Conde, S., … Vettoretto, N. (2023). European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery. Surgical Endoscopy, 37(3), 1629–1648. https://doi.org/10.1007/s00464-023-09928-5
Chen, H., Liu, C., Zhang, Y., & Li, Q. (2022). Application effect of ICG fluorescence real-time imaging in laparoscopic hepatectomy. Frontiers in Oncology, 12, 819960. https://doi.org/10.3389/fonc.2022.819960
Felli, E., Ishizawa, T., Cherkaoui, Z., Diana, M., Tripon, S., Baumert, T. F., Schuster, C., & Pessaux, P. (2021). Laparoscopic anatomical liver resection for malignancies using positive or negative staining technique with intraoperative indocyanine green-fluorescence imaging. HPB, 23(11), 1647–1655. https://doi.org/10.1016/j.hpb.2021.05.006
Gyoda, Y., Tokuda, K., Takahashi, H., & Sato, S. (2021). Narrative review of fluorescence imaging-guided liver surgery. Liver Surgery, 1(2), 45–58. https://doi.org/10.21037/ls-20-102
Jansen-Winkeln, B., Germann, I., Köhler, H., Mehdorn, M., Maktabi, M., Sucher, R., Barberio, M., Chalopin, C., Diana, M., Moulla, Y., & Gockel, I. (2021). Comparison of hyperspectral imaging and fluorescence angiography for the determination of the transection margin in colorectal resections: A comparative study. International Journal of Colorectal Disease, 36(2), 283–291. https://doi.org/10.1007/s00384-020-03755-z
Jung, J. M., Park, I. J., Park, E. J., Son, G. M., & Image-Guided Surgery Study Group of the Korean Society of Coloproctology. (2023). Fluorescence-guided colorectal surgery: Applications, clinical results, and protocols. Annals of Surgical Treatment and Research, 105(5), 252–263. https://doi.org/10.4174/astr.2023.105.5.252
Ladak, F., Dang, J. T., Switzer, N., Mocanu, V., Tian, C., Birch, D., Turner, S. R., & Karmali, S. (2019). Indocyanine green for the prevention of anastomotic leaks following esophagectomy: A meta-analysis. Surgical Endoscopy, 33(2), 384–394. https://doi.org/10.1007/s00464-018-6503-7
Mc Entee, P. D., Singaravelu, A., Boland, P. A., Moynihan, A., Creavin, B., & Cahill, R. A. (2025). Impact of indocyanine green fluorescence angiography on surgeon action and anastomotic leak in colorectal resections: A systematic review and meta-analysis. Surgical Endoscopy, 39(3), 1473–1489. https://doi.org/10.1007/s00464-025-11582-y
Pesce, A., Piccolo, G., Lecchi, F., Fabbri, N., Diana, M., & Feo, C. V. (2021). Fluorescent cholangiography: An up-to-date overview twelve years after the first clinical application. World Journal of Gastroenterology, 27(36), 5989–6003. https://doi.org/10.3748/wjg.v27.i36.5989
Polom, W., Migaczewski, M., Skokowski, J., Swierblewski, M., Cwalinski, T., Kalinowski, L., Pedziwiatr, M., Matuszewski, M., & Polom, K. (2022). Multispectral imaging using fluorescent properties of indocyanine green and methylene blue in colorectal surgery: Initial experience. Journal of Clinical Medicine, 11(2), 368. https://doi.org/10.3390/jcm11020368
Rinne, J. K., Huhta, H., Pinta, T., Turunen, A., Mattila, A., Tahkola, K., Helminen, O., Ohtonen, P., Rautio, T., & Kössi, J. (2025). Indocyanine green fluorescence imaging in prevention of colorectal anastomotic leakage: A randomized clinical trial. JAMA Surgery, 160(3), 245–253. https://pmc.ncbi.nlm.nih.gov/articles/PMC11883591/
Satish, V. R., Acharya, A., Ramachandran, S., Narasimhan, M., & Ardhanari, R. (2022). Fluorescent ureterography with indocyanine green in laparoscopic colorectal surgery: A safe method to prevent intraoperative ureteric injury. Journal of Minimal Access Surgery, 18(2), 320–323. https://doi.org/10.4103/jmas.jmas_183_21
Xia, S., Wu, W., Luo, L., Ma, L., Yu, L., & Li, Y. (2023). Indocyanine green fluorescence angiography decreases the risk of anastomotic leakage after rectal cancer surgery: A systematic review and meta-analysis. Frontiers in Medicine, 10, 1157389. https://doi.org/10.3389/fmed.2023.1157389
Zhang, Z., Fang, C., He, K., Su, S., Chi, C., Shi, X., Li, B., Cheng, Z., Hu, Z., & Tian, J. (2024). NIR-II fluorescence image-guided surgery prolongs the relapse-free survival of hepatocellular carcinoma patients. HPB, 26(7), 963–966. https://doi.org/10.1016/j.hpb.2024.04.008
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Copyright (c) 2025 Bruna Isabel Luzzani, Nathalia Bravo Fontolan Pedro, Marina Meneses de Carvalho Coelho, Cristiann Fernando da Silva Araújo, Marianna Maksoud Rodrigues, Nathan Gabriel Patussi Linares Pereira
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