Near-Infrared Fluorescence Imaging in General Surgery: Applications in Vascularization, Tumor Margin Detection, and...

Near-infrared fluorescence (NIRF) imaging has emerged as a transformative intraoperative tool in general surgery, helping in vascular surgery interventions, tumor margin detection in different specialties, and biliary anatomy with high sensitivity and safety. Indocyanine green remains the gold-standard fluorescent agent, widely applied in angiography, tumor margin detection, and fluorescence cholangiography, consistently improving surgical safety and efficiency with exceedingly low complication rates. Recent advances and trends include activatable and targeted probes, near-infrared II fluorophores, and nanoparticle-based agents, which expand specificity, depth of imaging, and multiplexing capacity. Integration with robotic systems in general surgery practice and artificial intelligence may further strengthen the precision of fluorescence-guided surgery, providing automated interpretation and workflow integration. Clinical outcomes demonstrate reduced operative times, improved anatomical visualization during operations, and enhanced tumor resection accuracy, while emerging technologies promise broader applications in complex oncologic and hepatopancreatobiliary surgery. Taken together, NIRF imaging represents a rapidly evolving field with the potential to redefine intraoperative guidance and precision in general surgery.