Discovering the previously unseen.

ZEISS Intraoperative Fluorescence Technologies

Deeper insights. Greater control.

Fluorescence is the property of atoms and molecules, so called fluorophores, to absorb light at a particular wavelength and to subsequently emit light of longer wavelength. Fluorescence microscopy can be based on autofluorescence or the addition of fluorescent dyes.1,2 Under normal light fluorescent dyes might be invisible. But a visualization system with integrated fluorescence technology lights up the dye to visualize tumor tissue or blood vessels during surgery.

The first use of intraoperative fluorescence imaging in surgery dates back to 1948 when surgeons used intravenous fluorescein to enhance intracranial neoplasms during neurosurgery.2,9 Since then, additional fluorescent agents have been used for a variety of surgical applications.4,5,6,9 Intraoperative fluorescence imaging offers the benefits of high contrast and sensitivity, absence of ionizing radiation, ease of use, safety, and high specificity.7,8,9 Compared with standard unaided vision using white light imaging, real-time fluorescence imaging is helpful in visualizing cancerous tissue and delineating tumor margins.8 Moreover, improved visualization of the cancer can reduce damage to important normal structures such as nerves, blood vessels, ureters, and bile ducts.9

In challenging microsurgery, surgical visualization adjuncts are essential for making the right decisions at the right time. The Intraoperative Fluorescence Technologies1 from ZEISS offer you the tools you need.

Intraoperative visualization of fluorescence-stained structures in tumor surgery

with ZEISS BLUE 400 and ZEISS YELLOW 560

Intraoperative imaging of cerebral blood flow in vascular surgery

with ZEISS INFRARED 800 and ZEISS FLOW 800

Intraoperative fluorescence imaging in reconstructive surgery

with ZEISS INFRARED 800 and ZEISS FLOW 800

Available services

  • 1 Please use the fluorescent agent as per the approval status for the application in your country.
  • 2 Stummer W, Pichlmeier U, Meinel T et al: Fluorescence-guided surgery for resection of malignant glioma: a randomized controlled multicentre phase III trial. In: Lancet Oncol 7: 392-401, 2006.
  • 3 Esteves S, Alves M, Castel-Branco M, Stummer W: A Pilot Cost-Effectiveeness Analysis of Treatments in Newly Diagnoes High-Grade Gliomas: The Example of 5-Aminoelvulinic Acid Compared With White-Light Surgery. In: Neurosurgery 76: 552–562, 2015.
  • 4 Acerb Fi, Cavallo C, Schebesch KM, et al.: Fluorescein-Guided Resection of Intramedullary Spinal Cord Tumors: Results from a Preliminary, Multicentric, Retrospective Study. In: World Neurosurgery 108: 603-609, 2017.
  • 5 Rey-Dios R, Cohen-Gadol AA: Technical principles and neurosurgical applications of fluorescein fluorescence using a microscope-integrated fluorescence module. In: Acta Neurochirurgica 155(4):701–706, 2013.
  • 6 De Laurentis C, Höhne J, Cavallo C, et al.: The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study. In: Journal of Neurosurgical Sciences 63(6): 679-687, 2019.
  • 7 Acerbi F, Broggi M, Schebesch KM, et al. Fluorescein-guided surgery for resection of high-grade gliomas: A multicentric prospective phase II study (FLUOGLIO). In: Clinical Cancer Research 24(1): 52-61, 2018.
  • 8 Schebesch KM, Proescholdt M, Höhne J, et al.: Sodium fluorescein-guided rescetion under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery – a feasibility study. In: Acta Neurochirurgica 157(6): 899–904, 2015.
  • 9 Höhne J, Hohenberger C, Proescholdt M, et al. Fluorescein sodium-guided resection of cerebral metastases-an update. In: Acta Neurochirurgica 159: 363-367, 2017.
  • 10 Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V: Near-Infrared Indocyanine Green Video Angiography: A New Method For Intraoperative Assessment Of Vascular Flow. In: Neurosurgery 52(1):132-139, 2003.
  • 11 Raabe A, Beck J, Seifert V: Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology. In: Zentralbl Neurochir 66(1):1–6, 2005.
  • 12 Kamp MA, Slotty P, Turowski B, Etminan N, Steiger HJ, Hänggi D, Stummer W: Microscope-integrated quantitative analysis of intraoperative indocyanine green fluorescence angiography for blood flow assessment: first experience in 30 patients. In: Operative Neurosurgery 70(1 Suppl Operative): 65-73, 2012.
  • 13 Mücke T, Reeps C, Wolff KD, et al.: Objective qualitative and quantitative assessment of blood flow with near-infrared angiography in microvascular anastomoses in the rat model. In: Microsurgery 33(4):287-96, 2013.
  • 14 Ye X, Liu XJ, Ma L, et al.: Clinical values of intraoperative indocyanine green fluorescence video angiography with Flow 800 software in cerebrovascular surgery. In: Chinese Medical Journal 126(22): 4232-4237, 2013.
  • 15 Holling M, Brokinkel B, Ewelt C, et al.: Dynamic ICG fluorescence provides better intraoperative understanding of arteriovenous fistulae. In: Operative Neurosurgery 73(Issue suool_1): 93-99, 2013.
  • 16 Ng YP, King NK, Wan KR, et al.: Uses and limitations of indocyanine green videoangiography for flow analysis in arteriovenous malformation surgery. In: Journal of Clinical Neuroscience 20(2): 224-232, 2013.
  • 17 Holzbach T, Artunian N, Spanholtz TA, et al.: Intraoperative Indocyaningrün-Fluoreszenzdiagnostik mittels Operationsmikroskop in der plastischen Chirurgie. In: Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie 44(2):84-8, 2012.
  • 18 Mücke T, Fichter AM, Schmidt LH, et al.: Indocyanine green videoangiography-assisted prediction of flap necrosis in the rat epigastric flap using FLOW® 800 Tool. In: Microsurgery 37:235–242, 2017.
  • 19 Mücke T, Wolff C, Fichter AM, et al.: Detection of thrombosis in microvessels with indocyanine green videoangiography. In: British Journal of Oral and Maxillofacial Surgery 56(8): 678-683, 2018.
  • 20 Yamato T, Yamamoto N, Numahata T, et al.: Navigation Lymphatic Supermicrosurgery for the Treatment of Cancer-Related Peripheral Lymphedema. In: Vascular and Endovascular Surgery 48(2):139-143, 2014.
  • 21 Höhne J, Schebesch KM, de Laurentis C, Akçakaya MO, Pedersen CB, Brawanski A, Poulsen FR, Kiris T, Cavallo C, Broggi M, Ferroli P, Acerbi F Fluorescein Sodium in the Surgical Treatment of Recurrent Glioblastoma Multiforme. World Neurosurg. 2019 May;125:E158-E164. Epub 2019 Jan 22.
  • 22 Stage image: left-temporal craniatomy for tumor resection with YELLOW 560. Image courtesy of Dr. Peter Nakaji, Barrow Neurological Institute, Phoenix Arizona, USA