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

N. Vettoretto, E. Foglia, L. Ferrario, C. Gerardi, B. Molteni, U. Nocco, E. Lettieri, S. Molfino, G. L. Baiocchi, U. Elmore, R. Rosati, G. Currò, E. Cassinotti, L. Boni, R. Cirocchi, A. Marano, W. L. Petz, A. Arezzo, M. A. Bonino, F. DaviniA. Biondi, G. Anania, F. Agresta, G. Silecchia

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalSurgical Endoscopy
DOIs
Publication statusAccepted/In press - Jan 1 2020

Keywords

  • Fluorescence
  • Indocyanine green
  • Laparoscopy
  • Surgery

ASJC Scopus subject areas

  • Surgery

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    Vettoretto, N., Foglia, E., Ferrario, L., Gerardi, C., Molteni, B., Nocco, U., Lettieri, E., Molfino, S., Baiocchi, G. L., Elmore, U., Rosati, R., Currò, G., Cassinotti, E., Boni, L., Cirocchi, R., Marano, A., Petz, W. L., Arezzo, A., Bonino, M. A., ... Silecchia, G. (Accepted/In press). Could fluorescence-guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary. Surgical Endoscopy. https://doi.org/10.1007/s00464-020-07542-3