Background: Optimal visualization of the operative field and methods that additionally provide supportive optical information form the basis for target-directed and successful surgery. This article strives to give an overview of current enhanced visualization techniques in visceral surgery and to highlight future developments. Methods: The article was written as a comprehensive review on this topic and is based on a MEDLINE search and ongoing research from our own group and from other working groups. Results: Various techniques for enhanced visualization are described comprising augmented reality, unspecific and targeted staining methods, and optical modalities such as narrow-band imaging. All facilitate our surgical performance; however, due to missing randomized controlled studies for most of the innovations reported on, the available evidence is low. Conclusion: Many new visualization technologies are emerging with the aim to improve our perception of the surgical field leading to less invasive, target-oriented, and elegant treatment forms that are of significant benefit to our patients.

1.
Bernhardt S, Nicolau SA, Soler L, Doignon C: The status of augmented reality in laparoscopic surgery as of 2016. Med Image Anal 2017;37:66-90.
2.
Nicolau S, Soler L, Mutter D, Marescaux J: Augmented reality in laparoscopic surgical oncology. Surg Oncol 2011;20:189-201.
3.
Gavaghan K A, Peterhans M, Oliveira-Santos T, Weber S: A portable image overlay projection device for computer-aided open liver surgery. IEEE Trans Biomed Eng 2011;58:1855-1864.
4.
Kenngott HG, Wagner M, Nickel F, et al: Computer-assisted abdominal surgery: new technologies. Langenbecks Arch Surg 2015;400:273-281.
5.
Najmaei N, Mostafavi K, Shahbazi S, Azizian M: Image-guided techniques in renal and hepatic interventions. Int J Med Robot 2013;9:379-395.
6.
Kleemann M, Deichmann S, Esnaashari H, et al: Laparoscopic navigated liver resection: technical aspects and clinical practice in benign liver tumors. Case Rep Surg 2012;2012:265918.
7.
Shahin O, Beširević A, Kleemann M, Schlaefer A: Ultrasound-based tumor movement compensation during navigated laparoscopic liver interventions. Surg Endosc 2014;28:1734-1741.
8.
Raabe A, Krishnan R, Seifert V: Actual aspects of image-guided surgery. Surg Technol Int 2003;11:314-319.
9.
Haase S, Bauer S, Wasza J, et al: 3-D operation situs reconstruction with time-of-flight satellite cameras using photogeometric data fusion. Med Image Comput Comput Assist Interv 2013;16:356-363.
10.
Maier-Hein L, Mountney P, Bartoli A, et al: Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery. Med Image Anal 2013;17:974-996.
11.
Horeman T, Rodrigues SP, van den Dobbelsteen JJ, et al: Visual force feedback in laparoscopic training. Surg Endosc 2012;26:242-248.
12.
Marcus HJ, Pratt P, Hughes-Hallett A, et al: Comparative effectiveness and safety of image guidance systems in surgery: a preclinical randomised study. Lancet 2015;385(suppl 1):S64.
13.
Meola A, Cutolo F, Carbone M, et al: Augmented reality in neurosurgery: a systematic review. Neurosurg Rev 2017;40:537-548.
14.
Okamoto T, Onda S, Yanaga K, et al: Clinical application of navigation surgery using augmented reality in the abdominal field. Surg Today 2015;45:397-406.
15.
Pessaux P, Diana M, Soler L, et al: Towards cybernetic surgery: robotic and augmented reality-assisted liver segmentectomy. Langenbecks Arch Surg 2015;400:381-385.
16.
Tang R, Ma L, Xiang C, et al: Augmented reality navigation in open surgery for hilar cholangiocarcinoma resection with hemihepatectomy using video-based in situ three-dimensional anatomical modeling: a case report. Medicine (Baltimore) 2017;96:e8083.
17.
Nakamoto M, Ukimura O, Faber K, Gill IS: Current progress on augmented reality visualization in endoscopic surgery. Curr Opin Urol 2012;22:121-126.
18.
Yeung JM, Maxwell-Armstrong C, Acheson AG: Colonic tattooing in laparoscopic surgery - making the mark? Colorectal Dis 2009;11:527-530.
19.
Cho YB, Lee WY, Yun HR, et al: Tumor localization for laparoscopic colorectal surgery. World J Surg 2007;31:1491-1495.
20.
Tummers WS, Warram JM, Tipirneni KE, et al: Regulatory aspects of optical methods and exogenous targets for cancer detection. Cancer Res 2017;77:2197-2206.
21.
Boni L, Fingerhut A, Marzorati A, et al: Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc 2017;31:1836-1840.
22.
Degett TH, Andersen HS, Gogenur I: Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbecks Arch Surg 2016;401:767-775.
23.
Burnier P, Niddam J, Bosc R, et al: Indocyanine green applications in plastic surgery: a review of the literature. J Plast Reconstr Aesthet Surg 2017;70:814-827.
24.
Holm C, Mayr M, Höfter E, et al: Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 2002;55:635-644.
25.
Boogerd LSF, Handgraaf HJM, Huurman VAL, et al: The best approach for laparoscopic fluorescence cholangiography: overview of the literature and optimization of dose and dosing time. Surg Innov 2017;24:386-396.
26.
Dip F, Nguyen D, Montorfano L, et al: Accuracy of near infrared-guided surgery in morbidly obese subjects undergoing laparoscopic cholecystectomy. Obes Surg 2016;26:525-530.
27.
Van der Vorst JR, Schaafsma BE, Hutteman M, et al: Near-infrared fluorescence-guided resection of colorectal liver metastases. Cancer 2013;119:3411-3418.
28.
De Boer E, Harlaar NJ, Taruttis A, et al: Optical innovations in surgery. Br J Surg 2015;102:e56-72.
29.
Aoki T, Yasuda D, Shimizu Y, et al: Image-guided liver mapping using fluorescence navigation system with indocyanine green for anatomical hepatic resection. World J Surg 2008;32:1763-1767.
30.
Diana M, Liu YY, Pop R, et al: Superselective intra-arterial hepatic injection of indocyanine green (ICG) for fluorescence image-guided segmental positive staining: experimental proof of the concept. Surg Endosc 2017;31:1451-1460.
31.
Cahill RA, Anderson M, Wang LM, et al: Near-infrared (NIR) laparoscopy for intraoperative lymphatic road-mapping and sentinel node identification during definitive surgical resection of early-stage colorectal neoplasia. Surg Endosc 2012;26:197-204.
32.
Liberale G, Bourgeois P, Larsimont D, et al: Indocyanine green fluorescence-guided surgery after IV injection in metastatic colorectal cancer: a systematic review. Eur J Surg Oncol 2017;43:1656-1667.
33.
Ishizawa T, Kaneko J, Inoue Y, et al: Application of fluorescent cholangiography to single-incision laparoscopic cholecystectomy. Surg Endosc 2011;25:2631-2636.
34.
Ntziachristos V: Fluorescence molecular imaging. Annu Rev Biomed Eng 2006;8:1-33.
35.
Winer JH, Choi HS, Gibbs-Strauss SL, et al: Intraoperative localization of insulinoma and normal pancreas using invisible near-infrared fluorescent light. Ann Surg Oncol 2010;17:1094-1100.
36.
Li Y, Rey-Dios R, Roberts DW, et al: Intraoperative fluorescence-guided resection of high-grade gliomas: a comparison of the present techniques and evolution of future strategies. World Neurosurg 2014;82:175-185.
37.
Kishi K, Fujiwara Y, Yano M, et al: Usefulness of diagnostic laparoscopy with 5-aminolevulinic acid (ALA)-mediated photodynamic diagnosis for the detection of peritoneal micrometastasis in advanced gastric cancer after chemotherapy. Surg Today 2016;46:1427-1434.
38.
Korb ML, Huh WK, Boone JD, et al: Laparoscopic fluorescent visualization of the ureter with intravenous IRDye800CW. J Minim Invasive Gynecol 2015;22:799-806.
39.
Hill TK, Mohs AM: Image-guided tumor surgery: will there be a role for fluorescent nanoparticles? Wiley Interdiscip Rev Nanomed Nanobiotechnol 2016;8:498-511.
40.
Van Dam GM, Themelis G, Crane LM, et al: Intraoperative tumor-specific fluorescence imaging in ovarian cancer by folate receptor-alpha targeting: first in-human results. Nat Med 2011;17:1315-1319.
41.
Keereweer S, Kerrebijn JD, van Driel PB, et al: Optical image-guided surgery - where do we stand? Mol Imaging Biol 2011;13:199-207.
42.
Terwisscha van Scheltinga AG, van Dam GM, Nagengast WB, et al: Intraoperative near-infrared fluorescence tumor imaging with vascular endothelial growth factor and human epidermal growth factor receptor 2 targeting antibodies. J Nucl Med 2011;52:1778-1785.
43.
Proulx ST, Luciani P, Christiansen A, et al: Use of a PEG-conjugated bright near-infrared dye for functional imaging of rerouting of tumor lymphatic drainage after sentinel lymph node metastasis. Biomaterials 2013;34:5128-5137.
44.
Wunderbaldinger P, Turetschek K, Bremer C: Near-infrared fluorescence imaging of lymph nodes using a new enzyme sensing activatable macromolecular optical probe. Eur Radiol 2003;13:2206-2211.
45.
Kaushal S, McElroy MK, Luiken GA, et al: Fluorophore-conjugated anti-CEA antibody for the intraoperative imaging of pancreatic and colorectal cancer. J Gastrointest Surg 2008;12:1938-1950.
46.
Sano K, Mitsunaga M, Nakajima T, et al: In vivo breast cancer characterization imaging using two monoclonal antibodies activatably labeled with near infrared fluorophores. Breast Cancer Res 2012;14:R61.
47.
Rosenthal EL, Warram JM, de Boer E, et al: Successful translation of fluorescence navigation during oncologic surgery: a consensus report. J Nucl Med 2016;57:144-150.
48.
Pierre SA, Ferrandino MN, Simmons WN, et al: High definition laparoscopy: objective assessment of performance characteristics and comparison with standard laparoscopy. J Endourol 2009;23:523-528.
49.
Wilhelm D, Reiser S, Kohn N, et al: Comparative evaluation of HD 2D/3D laparoscopic monitors and benchmarking to a theoretically ideal 3D pseudodisplay: even well-experienced laparoscopists perform better with 3D. Surg Endosc 2014;28:2387-2397.
50.
Storz P, Buess GF, Kunert W, Kirschniak A: 3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks. Surg Endosc 2012;26:1454-1460.
51.
Sorensen SM, Savran MM, Konge L, Bjerrum F: Three-dimensional versus two-dimensional vision in laparoscopy: a systematic review. Surg Endosc 2016;30:11-23.
52.
Hanna GB, Shimi SM, Cuschieri A: Randomised study of influence of two-dimensional versus three-dimensional imaging on performance of laparoscopic cholecystectomy. Lancet 1998;351:248-251.
53.
Curro G, La Malfa G, Lazzara S, et al: Three-dimensional versus two-dimensional laparoscopic cholecystectomy: is surgeon experience relevant? J Laparoendosc Adv Surg Tech A 2015;25:566-570.
54.
Agrusa A, di Buono G, Chianetta D, et al: Three-dimensional (3D) versus two-dimensional (2D) laparoscopic adrenalectomy: a case-control study. Int J Surg 2016;28(suppl 1):S114-117.
55.
Singh R, Lee SY, Vijay N, et al: Update on narrow band imaging in disorders of the upper gastrointestinal tract. Dig Endosc 2014;26:144-153.
56.
Schnelldorfer T, Jenkins RL, Birkett DH, Georgakoudi I: From shadow to light: visualization of extrahepatic bile ducts using image-enhanced laparoscopy. Surg Innov 2015;22:194-200.
57.
Kikuchi H, Kamiya K, Hiramatsu Y, et al: Laparoscopic narrow-band imaging for the diagnosis of peritoneal metastasis in gastric cancer. Ann Surg Oncol 2014;21:3954-3962.
58.
Falkinger M, Kranzfelder M, Wilhelm D, et al: Design of a test system for the development of advanced video chips and software algorithms. Surg Innov 2015;22:155-162.
59.
Nakai Y, Isayama H, Shinoura S, et al: Confocal laser endomicroscopy in gastrointestinal and pancreatobiliary diseases. Dig Endosc 2014;26(suppl 1):86-94.
60.
Kuiper T, van den Broek FJ, van Eeden S, et al: New classification for probe-based confocal laser endomicroscopy in the colon. Endoscopy 2011;43:1076-1081.
61.
Rehberger M, Wilhelm D, Janssen K-P, et al: Optical coherence tomography (OCT): the missing link in gastrointestinal imaging? Int J CARS 2016;11(suppl 1): 32-33.
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