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

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 journalArticlepeer-review


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. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.
Original languageEnglish
Pages (from-to)3270-3284
Number of pages15
JournalSurg. Endosc.
Issue number7
Publication statusPublished - 2020


  • Fluorescence
  • Indocyanine green
  • Laparoscopy
  • Surgery
  • indocyanine green
  • anastomosis leakage
  • Article
  • bariatric surgery
  • biliary tract surgery
  • biomedical technology assessment
  • breast surgery
  • cholecystectomy
  • clinical effectiveness
  • colorectal surgery
  • comparative study
  • economic evaluation
  • endocrine surgery
  • endoscopic surgery
  • esophagus surgery
  • evaluation study
  • fluorescence imaging
  • gynecologic surgery
  • health economics
  • hospitalization
  • human
  • length of stay
  • liver surgery
  • medical society
  • minimally invasive surgery
  • operation duration
  • pancreas surgery
  • pathology
  • patient safety
  • priority journal
  • qualitative research
  • questionnaire
  • stomach surgery
  • thorax surgery
  • urologic surgery


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