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

• Published in: Surgical endoscopy Vol. 34; no. 7; pp. 3270 - 3284
• Main Authors: 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., Davini, F., Biondi, A., Anania, G., Agresta, F., Silecchia, G.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-07-2020; Springer Nature B.V
• Subjects: Abdominal Surgery; Clinical medicine; Colorectal surgery; Cost analysis; Efficiency, Organizational; Endoscopy; Endoscopy - methods; Ethics; Fluorescence; Gastroenterology; Gastrointestinal surgery; Gynecology; Health economics; Health technology assessment; Hepatology; Human error; Humans; Indocyanine Green; Italy; Literature reviews; Medicine; Medicine & Public Health; New Technology; Operative Time; Proctology; Qualitative Research; Questionnaires; Societies, Medical; Society; Studies; Surgery; Surgery, Computer-Assisted - methods; Sustainability; Sustainable Development; Systematic Reviews as Topic; Technology Assessment, Biomedical; Thoracic surgery; Urology; Italy; Fluorescence; Indocyanine green; Laparoscopy; Surgery
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-020-07542-3

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.