Novel Imaging Technologies in Laparoscopic Gynecologic Surgery: A Systematic Review

Abstract

Novel imaging technologies continued to be introduced into the operative setting. In particular, novel image-enhanced laparoscopic techniques are being explored for use in gynecologic operations. This systematic review describes these technologies in four relevant areas of gynecologic surgery. The PubMed database was searched for human, English-language studies, and the reference lists of retrieved articles were reviewed. An analysis of pooled data from 34 studies that met inclusion criteria was performed. The results suggest that image-enhanced technology may be useful in several common gynecologic procedures. Auto- and drug-enhanced fluorescence laparoscopy allow for increased detection of nonpigmented endometriotic lesions. Using these technologies for peritoneal staging of ovarian malignancy is of uncertain benefit. Drug-enhanced fluorescence laparoscopy for sentinel lymph node (SLN) detection in patients with uterine or cervical malignancy is feasible, showing a high rate of SLN detection, but a low sensitivity of identifying metastases. Finally, their use in intra-operative visualization of the ureter is promising. The majority of available data was from feasibility studies with limited sample sizes. Nevertheless, the results described in this systematic review support the expectation that these upcoming image-enhanced laparoscopy techniques will play a more important role in the future care of gynecologic patients.