Laparoscopic Infrared Imaging—The Future Vascular Map Noam Shussman, MD, 1 Mahmoud Abu Gazala, MD, 1 Avraham Schlager, MD, 1,2 Ram Elazary, MD, 1 Abed Khalaileh, MD, 1 Gideon Zamir, MD, 1 David Kushnir, BSc, 1 Avraham I. Rivkind, MD, FACS, 1 and Yoav Mintz, MD 1 Abstract Objective: One of the most significant limitations of laparoscopic surgery is the inability to achieve tactile assessment of structures during surgical dissection. Because blood vessels are naturally warmer than their surroundings, infrared (IR) detection can be highly effective in identifying and mapping out their course. In recent years, IR detection has been used successfully for this purpose in open surgery. Nevertheless, this technology has to be yet employed in laparoscopic surgery, where its contribution would be greatest. Methods: We performed a feasibility study using this technology on live porcine models. After insertion of IR detectors into the insufflated abdomen, we performed a series of laparoscopic procedures. During these oper- ations we evaluated the ability of the IR detector to identify blood vessels as well as the effects of local and systemic changes in temperature. Results: The IR detector successfully identified concealed blood vessels as well as acute bleeding. Cool lavage and insufflation with room-temperature CO 2 accentuated IR detection of blood vessels, whereas warm CO 2 and systemic temperature changes did not affect detection. Additionally, localized heating of tissue on the operative field using electrocautery did not interfere with IR sensitivity. Conclusion: Laparoscopic IR imaging is a feasible method of blood vessel detection in laparoscopic procedures. Use of IR blood vessel detection in laparoscopy has a potential to enable safer surgery and reduce operative time. Fusion of IR imaging with the standard laparoscopic view is currently being developed to allow real-time vessel mapping during laparoscopic procedures. Introduction L aparoscopy has revolutionized the art of surgery. Al- though the advantages of decreased pain, early mobili- zation, decreased incidence of wound-related complications, and improved cosmesis are well known, disadvantages exist, which limit the ability to perform certain procedures lapar- oscopically. The limitations of two-dimensional vision and inability to palpate the tissues are two major issues that re- duce the surgeon’s ability to perceive the operative field, thereby increasing the operative times and exposing the pa- tient to unnecessary surgical risks. In 2004, the concept of performing abdominal surgery without abdominal wall incision was introduced, an idea to be given later the name ‘‘natural orifice transluminal endo- scopic surgery’’ (NOTES). 1 The purpose of NOTES was to maximize the minimal invasiveness of laparoscopic surgery and reduce incision-related complications. 2 After only 5 years since the first publication on the topic, interest in the field has been growing by leaps and bounds. Many surgeons are now gaining experience in performing cholecystectomy, splenec- tomy, oophorectomy, small bowel resection and anastomosis, and other various operations via NOTES in both human and animal models. 3–10 To date, the institutions that have intro- duced this approach use it mostly to perform cholecystectomy and appendectomy. Single-incision laparoscopic surgery (SILS) is another technique that has been introduced during the last few years, which has become increasingly popular and represents the further progression of minimally invasive surgery. This pro- gression emphasizes the current technical obstacles in this field, as discussed earlier. To perform SILS and NOTES safely, we must overcome these technical difficulties. Visible light is an electromagnetic radiation with wave- lengths of 0.4–0.7 lm. Infrared (IR) radiation is composed of electromagnetic waves with a lower frequency and longer 1 Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel. 2 Department of Surgery, New York University, New York, New York. JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 21, Number 9, 2011 ª Mary Ann Liebert, Inc. DOI: 10.1089/lap.2010.0474 797