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

Autor: Vettoretto N; Chirurgia Montichiari, Azienda Socio Sanitaria Territoriale Degli Spedali Civili, V.le Ciotti 154, Montichiari, 25018, Brescia, Italy. nereovet@gmail.com., Foglia E; LIUC - Università Cattaneo, Castellanza, VA, Italy., Ferrario L; LIUC - Università Cattaneo, Castellanza, VA, Italy., Gerardi C; Centro di Politiche Regolatorie, Istituto di Ricerche Farmacologiche 'Mario Negri' IRCCS, Milan, Italy., Molteni B; Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy., Nocco U; Ingegneria Clinica, Azienda Socio Sanitaria Territoriale dei Sette Laghi, Varese, Italy., Lettieri E; School of Management, Department of Management, Economics and Industrial Engineering, Politecnico, Milano, Italy., Molfino S; Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy., Baiocchi GL; Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy., Elmore U; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Rosati R; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Currò G; Department of Human Pathology of Adult and Evolutive Age, University Hospital of Messina, Messina, Italy., Cassinotti E; Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy., Boni L; Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy., Cirocchi R; Department of Surgical Sciences, University of Perugia, Perugia, Italy., Marano A; Chirurgia Generale ed Oncologica, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy., Petz WL; Chirurgia, IEO, European Institute of Oncology IRCCS, Milan, Italy., Arezzo A; Department of Surgical Sciences, University of Torino, Turin, Italy., Bonino MA; Department of Surgical Sciences, University of Torino, Turin, Italy., Davini F; Centro multidisciplinare Chirurgia Robotica, Chirurgia Toracica mini-invasiva e Robotica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy., Biondi A; Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy., Anania G; Chirurgia Generale, University of Ferrara, Ferrara, Italy., Agresta F; Chirurgia Generale, Azienda ULSS 5 'Polesana', Hospital of Adria, Adria, RO, Italy., Silecchia G; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, Rome, Italy.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2020 Jul; Vol. 34 (7), pp. 3270-3284.
DOI: 10.1007/s00464-020-07542-3
Abstrakt: 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.
Databáze: MEDLINE
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