Bold claim: a breakthrough in esophageal surgery is redefining how perfusion is assessed and how safely a gastric conduit can be prepared. And here’s how it unfolds: HKU researchers have pioneered the use of NIR-II fluorescence video imaging during esophagectomy, the first clinical application of this wavelength range (1000–3000 nm) in upper GI surgery. The result is clearer, deeper, and more objective visualization of blood flow, helping surgeons choose where to cut and connect with far less guesswork.
A multidisciplinary team led by Professor Hongjie Dai and Professor Simon Law at The University of Hong Kong demonstrated that NIR-II imaging, when paired with rapid computational video analysis, can delineate well-perfused from poorly perfused tissue in real time. This operator-independent guidance addresses a long-standing risk in esophagectomy: anastomotic leakage, a serious complication that occurs in roughly 10–30% of cases and can lead to severe morbidity or death. In Hong Kong, around 30 patients have already benefited from this approach, with results that look highly promising so far.
Why this matters: traditional NIR-I fluorescence imaging uses indocyanine green (ICG) with standard near-infrared equipment. While widespread, NIR-I has limited tissue penetration, higher background signals, and lower resolution due to light scattering and autofluorescence. Relying on visual interpretation of these suboptimal images makes it difficult to pinpoint the exact perfusion boundary along the gastric conduit, leaving room for subjective judgment.
The NIR-II advance changes the game. This imaging window reduces scattering and autofluorescence, delivering sharper, more detailed views of blood perfusion. The HKU team built an imaging system capable of capturing both conventional photographs and NIR-II fluorescence simultaneously, and they integrated a fast intraoperative computational analysis that identifies well- and poorly-perfused regions within about one minute after dye administration. In practice, this enables surgeons to resect or reconstruct at precisely well-perfused sites, reducing the risk of leakage.
Key voices from the study emphasize the collaboration and clinical translation. Professor Dai highlights the cross-disciplinary teamwork that moved the imaging technology from mouse models to human patients. Professor Law stresses the objective, real-time guidance it affords during esophagectomy, enabling accurate assessment of blood supply and safer anastomotic planning. The implications extend beyond esophagectomy, offering infrared-guided precision for tumor visualization, vascular mapping, ureter detection, and sentinel lymph node identification in complex surgeries.
Context and collaboration: this work is part of Hong Kong’s RAISe+ initiative, with partnerships spanning the JC STEM Lab of Nanoscience and Nanomedicine and the Materials Institute of Life Sciences and Energy (MILES) in Shenzhen. The overarching aim is to push surgical performance forward using advanced dyes and imaging tools that operate in the NIR-II window, effectively providing surgeons with more reliable “infrared vision” during procedures.
Publication and team: the findings appear in Proceedings of the National Academy of Sciences (PNAS). The HKU team includes Professor Hongjie Dai (chemistry, mechanical engineering, biomedical sciences, and MILES), Professor Simon Law (gastrointestinal surgery and clinical medicine), Professor Feifei Wang (electrical and electronic engineering and MILES), and Dr. Ian Wong (clinical surgery).
Controversial angle and questions for discussion: as NIR-II imaging becomes more integrated into operating rooms, debates may arise about cost, accessibility, and the learning curve for widespread adoption. Should every esophagectomy carry this technology, or will adoption be limited to high-volume centers first? Do the benefits in reduced leakage rates justify the investment, especially in settings with constrained resources? What ethical considerations emerge when operator-independent tools influence surgical decisions that were once guided by surgeon experience alone? Share your thoughts in the comments: do you think NIR-II perfusion imaging represents a standard-of-care improvement, or a promising but incremental advance?
For reference, this summary is drawn from the HKU study on NIR-II fluorescence imaging in esophagectomy, as reported in PNAS and related press materials.
