Fluorescence guided surgery: lessons to learn from 15 years of clinical perfusion evaluation

Fluorescence guided surgery (FGS) has entered clinical practice over the past fifteen years and has established specific clinical niches of real patient benefit. The next phase will broaden the clinical application spectrum and harness breakthrough advances in computer vision and artificial intelligence methods to optimise interpretation especially of dynamic signals that will allow better usage of and impact from new agents and imaging methods. With a focus on tissue characterisation regarding perfusion sufficiency and pathological classification (in particular in situ digital cancer discrimination) in colorectal surgery, the current and near future state of the art is here described in the context of determinant clinical trials, experience and failures since the inception of FGS with a focus on work from our collaborative translational research group and on the remaining next steps for standard of care designation.