Oct. 09, 2026
Fluorescence-guided surgery (FGS) is transforming the way surgeons visualize anatomy and disease during an operation. By combining specialized fluorescent agents with advanced imaging systems, surgeons can identify critical structures, assess tissue perfusion, and more precisely locate tumors that may otherwise be difficult or impossible to see with conventional surgical techniques. Stephanie F. Polites, M.D., M.P.H., a pediatric surgeon and chair of Pediatric Surgery at Mayo Clinic in Rochester, Minnesota, is helping advance the field through both clinical application and research aimed at improving surgical outcomes for children with cancer and other complex conditions.
Making the invisible visible
In surgery, important anatomical structures and tumors may lie just below the surface or appear indistinguishable from surrounding tissue. This makes them difficult to visualize with conventional techniques, particularly during minimally invasive procedures. Fluorescence-guided surgery addresses this challenge by using specialized dyes that emit signals detectable by near-infrared imaging systems.
"What fluorescence-guided surgery does is make structures, organs and tumors visible through specialized imaging systems in ways that wouldn't otherwise be possible with the human eye," Dr. Polites says.
Patients receive a fluorescent agent, typically through a simple intravenous line, either during surgery or just prior to it. Surgeons then use specialized cameras integrated into laparoscopic, robotic or open surgical platforms to visualize tissues that have absorbed or retained the dye.
Applications in pediatric cancer surgery
At Mayo Clinic, fluorescence-guided surgery is being used to support the surgical management of a range of pediatric malignancies, including pulmonary metastases, liver tumors and bone tumors. By enhancing intraoperative visualization, fluorescent imaging can help surgeons identify tumor deposits that may not be detected on preoperative imaging or visible using conventional surgical techniques. In some cases, these technologies reveal additional sites of disease, providing a more comprehensive assessment of tumor burden during resection.
The ability to more precisely localize disease is particularly relevant in pediatric surgical oncology, where complete tumor resection remains a cornerstone of treatment for many solid tumors. At the same time, preserving typical anatomy and function is essential to support long-term growth, development and quality of life. Fluorescence-guided techniques can help surgeons balance these objectives by improving visualization of both malignant tissue and critical adjacent structures during complex resections.
In addition to tumor identification, fluorescence-guided surgery can assist in the localization and preservation of nearby structures, such as ureters, that may be at risk during oncologic procedures. This added anatomical definition may support safer resections while helping surgeons achieve oncologic goals with greater precision.
"Our goal is not only complete tumor resection but also preservation of the normal anatomy and function that children will rely on throughout their lives," Dr. Polites says.
Beyond oncology: Protecting critical structures
Fluorescence-guided surgery also has important applications outside of cancer care. One widely used fluorescent agent, indocyanine green (ICG), can be used to visualize blood flow, assess tissue perfusion and identify biliary anatomy during hepatobiliary surgery.
In pediatric gallbladder and bile duct procedures, fluorescence imaging helps surgeons distinguish critical structures and avoid injury to the common bile duct. The technology also is being explored for conditions such as biliary atresia, where accurate identification of bile drainage pathways can have significant implications for long-term liver function.
Driving the future of precision surgery
The field is now moving beyond first-generation dyes such as ICG toward newer targeted fluorescent agents designed to bind specific tumor markers. Mayo Clinic is among the institutions helping evaluate these next-generation technologies in pediatric patients through clinical research.
According to Dr. Polites, these advances represent an important extension of precision medicine into the operating room.
"This is what's so exciting about fluorescence-guided surgery," she says. "Just like different medications are becoming more precise and more tailored to patients' individual biology and genetics, we're doing the same in surgery."
For more information
Refer a patient to Mayo Clinic.