Novel Imaging Technique Helps View Blood Perfusion During Esophageal Surgery

Esophagectomy is a complex and high-risk surgery often required for esophageal cancer, with anastomotic leakage remaining one of its most serious complications. This defect at the surgical suture line affects 10–30% of patients and can lead to severe postoperative morbidity or death. Accurately assessing blood supply to the reconstructed gastric conduit is critical but remains challenging with existing imaging tools. A new intraoperative imaging approach now enables clearer, objective identification of well-perfused tissue to support safer surgical decisions.

A research team comprising experts in chemistry, biomedical science, engineering, and gastrointestinal surgery from The University of Hong Kong (HKU) (Hong Kong, China) has introduced near-infrared II (NIR-II, 1000–3000 nm) fluorescence video imaging into human esophagectomy for the first time. This approach builds on earlier preclinical advances showing that longer infrared wavelengths reduce light scattering and tissue autofluorescence.

The system simultaneously captures standard photographic images and NIR-II fluorescence images after administration of a fluorescent dye. High-resolution NIR-II videos are then processed using rapid computational analysis to objectively delineate boundaries between well-perfused and poorly perfused tissue. This operator-independent method provides surgeons with precise guidance on where to perform reconstruction, reducing reliance on subjective visual interpretation.

The technology was applied during esophagectomy in approximately 30 patients in Hong Kong, with highly promising outcomes reported to date. Compared with conventional NIR-I imaging, NIR-II imaging delivered markedly superior contrast, resolution, and depth of visualization of blood flow in gastric conduits. The findings were published in Proceedings of the National Academy of Sciences, marking the first successful clinical translation of NIR-II fluorescence imaging for upper gastrointestinal surgery.

In addition to esophagectomy, the platform addresses long-standing limitations of shallow imaging depth and low image quality in surgery. The approach has potential applications in precise tumor removal, ureter detection, and sentinel lymph node identification, offering surgeons enhanced “infrared vision” during complex procedures. Ongoing efforts aim to further expand clinical adoption and integrate advanced dyes and imaging tools for broader surgical use.

“This innovation offers objective guidance for surgical decisions in esophagectomy,” said Professor Simon Ying Kit Law, co-leader of the study. “It enables surgeons to accurately assess blood supply and perform anastomosis in well-perfused areas, thereby reducing the risk of anastomotic leakage and significantly improving surgical safety.”

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