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Dr. R.K. Mishra on Stryker’s Fluorescence-Guided Surgery: A Case in BOX In the ever-evolving field of minimally invasive surgery, technological advancements continue to redefine surgical precision, patient outcomes, and the overall approach to complex procedures. One such groundbreaking innovation is fluorescence-guided surgery (FGS), a technique that leverages near-infrared imaging to enhance intraoperative visualization. Among the pioneers embracing and advancing this technology is Dr. R.K. Mishra, a globally renowned laparoscopic and robotic surgeon. Known for his extensive contributions to minimal access surgery, Dr. Mishra has integrated Stryker’s cutting-edge fluorescence-guided surgery systems, such as the 1688 Advanced Imaging Modalities (AIM) 4K platform, into his practice and training programs. This article explores Dr. Mishra’s insights and experiences with Stryker’s FGS technology, focusing on its application in a "Case in BOX" scenario—a term that encapsulates a controlled, exemplary surgical case highlighting the technology’s potential. Who is Dr. R.K. Mishra? Before delving into the specifics of fluorescence-guided surgery, it’s essential to understand the expertise Dr. R.K. Mishra brings to the table. A professor of minimal access surgery with over two decades of experience, Dr. Mishra is the Chairman and Managing Director of World Laparoscopy Hospital in Gurugram, India. He has trained over 11,000 surgeons and gynecologists from 138 countries in laparoscopic techniques and more than 2,000 in da Vinci robotic surgery. His academic journey includes a Master’s degree in Minimal Access Surgery from the University of Dundee, UK, under the mentorship of Professor Sir Alfred Cuschieri, and further robotic surgery training at Harvard Medical School, USA. As a prolific author and editor-in-chief of the World Journal of Laparoscopic Surgery, Dr. Mishra has consistently pushed the boundaries of surgical innovation, making him a credible authority on advanced surgical technologies like FGS. Understanding Stryker’s Fluorescence-Guided Surgery Stryker, a leading medical technology company, has developed advanced imaging platforms that integrate fluorescence-guided surgery into minimally invasive procedures. The 1688 AIM 4K platform, for instance, combines high-definition 4K visualization with near-infrared fluorescence imaging, using agents like indocyanine green (ICG). This technology allows surgeons to visualize blood flow, tissue perfusion, lymphatics, and critical anatomical structures in real-time, beyond what is possible with standard white-light imaging. The fluorescence capability enhances the surgeon’s ability to differentiate between healthy and pathological tissues, assess perfusion, and identify vital structures such as bile ducts or ureters during surgery. Fluorescence-guided surgery relies on the administration of a fluorescent dye, typically ICG, which is injected into the patient. When illuminated by near-infrared light, the dye emits fluorescence that is captured by Stryker’s specialized cameras and displayed on a monitor. This provides a dynamic, high-contrast view of the surgical field, enabling precise decision-making during complex procedures. Dr. Mishra’s Perspective on Fluorescence-Guided Surgery Dr. Mishra has long championed the adoption of innovative tools to enhance surgical outcomes, and his endorsement of Stryker’s FGS technology is rooted in its transformative potential. He views FGS as a game-changer in minimally invasive surgery, particularly for its ability to provide real-time intraoperative guidance. “Traditional surgery relies heavily on the surgeon’s visual and tactile perception under white light,” Dr. Mishra explains. “Fluorescence-guided surgery adds a new dimension, allowing us to see what was previously invisible. It’s like giving surgeons a superpower to navigate the human body with greater accuracy.” In his extensive experience, Dr. Mishra has utilized Stryker’s FGS in various procedures, including laparoscopic cholecystectomy, hernia repairs, and advanced gastrointestinal surgeries. He emphasizes that the technology’s ability to assess tissue perfusion and delineate anatomical structures reduces the risk of complications such as bile duct injuries or anastomotic leaks—common challenges in minimally invasive surgery. Case in BOX: A Demonstrative Application A "Case in BOX" refers to a controlled, illustrative surgical scenario designed to showcase the efficacy of a specific technique or technology. In this context, Dr. Mishra highlights a laparoscopic cholecystectomy performed using Stryker’s 1688 AIM 4K platform as an exemplary case. Laparoscopic cholecystectomy, the removal of the gallbladder, is one of the most common minimally invasive procedures, yet it carries risks such as bile duct injury due to poor visualization of the cystic duct or aberrant anatomy. In this Case in BOX, Dr. Mishra describes how Stryker’s FGS enhances the procedure. After administering ICG intravenously, the dye is taken up by the liver and excreted into the bile, illuminating the biliary tree under near-infrared light. “With Stryker’s system, we can clearly visualize the cystic duct, common bile duct, and hepatic ducts in real-time,” he notes. “This reduces the guesswork and ensures we avoid unintended damage to critical structures.” The fluorescence imaging also allows for a quick assessment of gallbladder perfusion, confirming the viability of tissues before and after dissection. Dr. Mishra performed this procedure at World Laparoscopy Hospital, where he demonstrated the technology to a group of trainees. The case was recorded and later analyzed to highlight key moments where FGS made a difference—such as identifying a partially obscured cystic duct that might have been missed under standard visualization. “This is the kind of case that proves the value of fluorescence-guided surgery,” he asserts. “It’s not just about improving outcomes for the patient on the table; it’s about equipping surgeons with tools to handle variability and complexity with confidence.” Conclusion Dr. R.K. Mishra’s work with Stryker’s fluorescence-guided surgery exemplifies the intersection of surgical expertise and technological innovation. His insights from the "Case in BOX" scenario underscore how FGS enhances precision, safety, and education in minimally invasive surgery. As a leader in the field, Dr. Mishra continues to bridge the gap between cutting-edge tools and practical application, ensuring that technologies like Stryker’s 1688 AIM 4K platform benefit both surgeons and patients worldwide. With his forward-thinking approach, the future of fluorescence-guided surgery looks bright, promising a new era of clarity and confidence in the operating room.