Biofluorescence in surgery: Present and future

Biofluorescence is a physical phenomenon that has gained a multitude of clinical applications since its introduction to medicine in the 1940s. The utilisation of biofluorescence in colorectal surgery has grown from the development of the fluorophore indocyanine green (ICG) and its prior applications in assessing vascular beds in other fields of surgery. However, despite the increasing adoption of ICG in the assessment of colonic conduit perfusion, the evidence base for its utilisation remains controversial, although a range of other uses for this technology are emerging. Advances in semi-quantitative and artificial intelligence augmented platforms are providing greater objectivity in the application of biofluorescent techniques in colorectal surgery, although they are still in a largely developmental phase. Molecular-targeted biofluorescent technologies are also opening up new surgical paradigms for intraoperative real-time assessment of tumours and their locoregional spread and may in time facilitate surgeons to find equipoise in the radicality of oncologic resection.