34th Annual Scientific Meeting proceedings

Near-infrared fluorescence (NIRF) imaging has emerged as a promising tool in veterinary surgery, offering real-time, dynamic visualization of structures and functions that are otherwise invisible to the naked eye. Applications such as perfusion assessment, sentinel lymph node mapping, biliary tract identification, and ureter visualization have been translated from human to veterinary medicine with growing interest. However, as the technology becomes more accessible, it is essential to critically examine its current role, limitations, and future trajectory.

Current veterinary applications are largely extrapolated from human protocols and are supported by case reports, small-scale studies, or experimental models. While early results suggest that NIRF may enhance intraoperative decision-making, the evidence base is still insufficient to draw firm conclusions about its impact on clinical outcomes. The absence of standardized endpoints, control groups, or large multicenter trials makes it difficult to assess true benefit. This gap underscores the need for careful indication selection—avoiding the temptation to use NIRF based solely on its novelty or visual appeal. Within the next 10 yars, it is our responsibility to devliver structured evidence to build a solid range of indications.

In addition, there are currently other major challanges. One of the most significant technical challenges facing the field is the lack of standardization across imaging platforms. Numerous NIRF camera systems are commercially available, each with different excitation sources, sensitivities, and detection algorithms. There is currently no cross-validation or benchmarking framework, making it difficult to compare results across institutions or studies. This heterogeneity limits reproducibility and impedes the development of consensus guidelines. During the next ten years, we need to validate the available imaging systems, define their strengths and limitations, and determine the best imager-dye combination per indication.

Another key barrier to wider implementation is the lack of structured training and certification. At present, there are no standardized curricula for veterinary surgeons wishing to incorporate NIRF into their practice. As with any new modality, operator experience plays a crucial role in the accuracy and interpretation of findings. Developing high-quality training courses and simulation-based platforms will be vital to ensure safe and effective use.

Looking toward the next decade, progress will depend on several strategic initiatives:

1. rigorous clinical trials evaluating NIRF’s impact on outcomes;
2. identification of optimal fluorophore–imager–indication combinations, including exploration of targeted dyes for oncologic use;
3. standardization and validation of imaging systems; and (4) creation of formal educational pathways to train the next generation of users.

Interdisciplinary collaboration between clinicians, engineers, and imaging scientists will be key to driving innovation while maintaining clinical relevance.

In summary, NIRF surgery holds considerable potential to enhance veterinary surgical care, but its adoption must be cautious, evidence-driven, and patient-centered. By investing in standardization, training, and translational research, we can ensure that this powerful technology finds its rightful place in the surgical toolbox of the future.

Fluorescence guided surgery is here to stay- it is now on us to make it most effective!