Cahill R A, Mortensen N J
Department of Colorectal Surgery, Oxford Radcliffe Hospitals, Oxford, UK.
Minerva Chir. 2010 Aug;65(4):451-62.
Advances in imaging quality and capability have been the major driver of the laparoscopic revolution that has dramatically impacted upon operative strategies and surgical patient care in recent years. Increasingly now the technological capacity is becoming available to supraselect or extend the useful clinical range of the electromagnetic spectrum beyond visible or white light. This has markedly broadened the intraprocedural optical information available at intraluminal endoscopy and there is likely to be considerable similar benefit for laparoscopy. Rather than narrow band or ultraviolet imaging however, it is the near infrared (NIR) spectrum that seems of most potential to exploit during intra-abdominal endoscopy in particular as this energy range is capable of penetrating relatively deeply into tissues such as the mesentery and bowel wall without inducing thermal damage due to heat dissipation or indeed the intracellular effects associated with higher energy, shorter wavelength energies. By incorporating the NIR spectrum alongside more conventional laparoscopic imaging, a greater appreciation of tissue architecture, character and quality is possible in particular with respect to lymphatic and vascular channel anatomy and flow dynamics and also real-time optical histology (by NIR optical coherence tomography). Such a facility may significantly aid critical intraoperative decision making during colorectal operations by informing the surgeon regarding the most biologically relevant lymphatic basin and lymph nodes for any target area of interest (especially important if considering tailored operative extent for colorectal neoplasia), the sufficiency and quality of arterial supply (and hence inform re the perfusion of stapled intestinal ends prior to reanastomosis) and perhaps even in situ pathological assessment. This article provides a state of art overview of the fascinating potential of this emergent technological capability.
成像质量和能力的进步是腹腔镜革命的主要驱动力，近年来，腹腔镜革命对手术策略和手术患者护理产生了巨大影响。现在，越来越多的技术能力可用于超选择或扩展电磁光谱的有用临床范围，使其超出可见光或白光范围。这显著拓宽了腔内内窥镜检查术中可获得的光学信息，腹腔镜检查也可能有相当类似的益处。然而，在腹腔内内窥镜检查中，最具开发潜力的似乎不是窄带或紫外成像，而是近红外（NIR）光谱，特别是因为该能量范围能够相对深入地穿透肠系膜和肠壁等组织，而不会因热耗散或与更高能量、更短波长能量相关的细胞内效应而引起热损伤。通过将近红外光谱与更传统的腹腔镜成像相结合，尤其在淋巴管和血管通道解剖结构及血流动力学以及实时光学组织学（通过近红外光学相干断层扫描）方面，能够更深入地了解组织结构、特征和质量。这样一种功能可能会在结直肠手术中显著帮助关键的术中决策，为外科医生提供有关任何感兴趣目标区域最具生物学相关性的淋巴引流区和淋巴结的信息（如果考虑为结直肠肿瘤定制手术范围，这尤为重要）、动脉供应的充足性和质量（从而在重新吻合术前告知吻合口肠端的灌注情况），甚至可能有助于进行原位病理评估。本文对这种新兴技术能力的迷人潜力进行了综述。
