{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T10:08:10Z","timestamp":1777716490750,"version":"3.51.4"},"reference-count":38,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Objectives: Intraoperative assessment of tissue perfusion remains a decisive but imperfect step in abdominal surgery. Surgeons still rely heavily on visual judgement when choosing bowel transection lines, constructing anastomoses, judging intestinal viability, or assessing graft reperfusion, even though these decisions are directly linked to anastomotic leak, conduit ischemia, postoperative liver dysfunction, and graft failure. Hyperspectral imaging (HSI) is an emerging contrast-free optical technology that generates quantitative maps of tissue oxygenation, hemoglobin distribution, water content, and near-infrared perfusion. The present review was designed to evaluate whether clinical intraoperative HSI has matured sufficiently to support a focused systematic review topic in abdominal surgery and to synthesize the currently available human evidence. Methods: A literature search was conducted up to 20 February 2026 using combinations of the terms \u201chyperspectral imaging\u201d, \u201cHSI\u201d, \u201cabdominal surgery\u201d, \u201ccolorectal\u201d, \u201chepatectomy\u201d, \u201ctransplantation\u201d, \u201cpancreatoduodenectomy\u201d, \u201cesophagectomy\u201d, \u201cmesenteric ischemia\u201d, and \u201cintraoperative\u201d. Eligible records were original human clinical studies evaluating intraoperative HSI in abdominal or transplant-related operations with perfusion, oxygenation, or tissue viability as a central endpoint. Review articles, animal studies, non-surgical diagnostic studies, and single-patient case reports were excluded. Data were synthesized narratively because of major heterogeneity in indications, designs, devices, timing of measurements, and reported outcomes. Results: Thirteen studies published between 2019 and 2024 met the eligibility criteria, representing 391 patients. The literature covered colorectal resection, acute mesenteric ischemia, esophageal reconstruction with gastric or colonic conduits, pancreatoduodenectomy, pancreas transplantation, major hepatectomy, liver transplantation, and minimally invasive system validation. Across colorectal studies, HSI frequently demonstrated discordance between visually selected and objectively perfused transection lines, with clinically relevant strategy changes in a substantial proportion of patients. In ischemic and transplant settings, HSI discriminated poorly perfused tissue, identified low near-infrared perfusion values associated with early allograft dysfunction, and quantified reperfusion patterns after clamping or implantation. The evidence base was dominated by prospective single-center feasibility studies with small to moderate sample sizes, and no randomized trials were identified. Conclusions: Clinical intraoperative HSI in abdominal surgery is a genuinely niche yet rapidly expanding topic with a sufficient number of human studies to support a relevant systematic review. Current evidence consistently supports feasibility, quantitative perfusion discrimination, and plausible intraoperative utility, especially in colorectal and transplant-related surgery. However, the field remains methodologically heterogeneous, and the next research priority is multicenter standardization with clinically anchored thresholds and outcome-driven comparative studies.<\/jats:p>","DOI":"10.3390\/diagnostics16091336","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:46:11Z","timestamp":1777455971000},"page":"1336","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative Hyperspectral Imaging for Perfusion Assessment and Emerging Decision Support in Abdominal Surgery: A Systematic Review of Clinical Studies"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0497-0405","authenticated-orcid":false,"given":"Calin","family":"Muntean","sequence":"first","affiliation":[{"name":"Department III-Functional Sciences, Medical Informatics and Biostatistics, \u201cVictor Babe\u015f\u201d University of Medicine and Pharmacy Timi\u015foara, Eftimie Murgu Square No. 2, 300041 Timi\u015foara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melania Veronica","family":"Ardelean","sequence":"additional","affiliation":[{"name":"Department V, Internal Medicine I-Discipline of Medical Semiology I, \u201cVictor Babe\u015f\u201d University of Medicine and Pharmacy Timi\u015foara, Eftimie Murgu Square No. 2, 300041 Timi\u015foara, Romania"},{"name":"Center of Advanced Research in Cardiology and Hemostasology, \u201cVictor Babe\u015f\u201d University of Medicine and Pharmacy Timi\u015foara, Eftimie Murgu Square No. 2, 300041 Timi\u015foara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8647-1003","authenticated-orcid":false,"given":"Vasile","family":"Gaborean","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Research Center, \u201cVictor Babe\u015f\u201d University of Medicine and Pharmacy Timi\u015foara, Eftimie Murgu Square No. 2, 300041 Timi\u015foara, Romania"},{"name":"Department of Surgical Semiology, Faculty of Medicine, \u201cVictor Babe\u015f\u201d University of Medicine and Pharmacy Timi\u015foara, Eftimie Murgu Square No. 2, 300041 Timi\u015foara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alaviana Monique","family":"Faur","sequence":"additional","affiliation":[{"name":"Department of Doctoral Studies, \u201cVictor Babe\u015f\u201d University of Medicine and Pharmacy Timi\u015foara, Eftimie Murgu Square No. 2, 300041 Timi\u015foara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3277-1198","authenticated-orcid":false,"given":"Catalin Vladut Ionut","family":"Feier","sequence":"additional","affiliation":[{"name":"Abdominal Surgery and Phlebology Research Center, \u201cVictor Babe\u015f\u201d University of Medicine and Pharmacy Timi\u015foara, Eftimie Murgu Square No. 2, 300041 Timi\u015foara, Romania"},{"name":"First Surgery Clinic, \u201cPius Brinzeu\u201d Clinical Emergency Hospital, 300723 Timi\u015foara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Barberio, M., Benedicenti, S., Pizzicannella, M., Felli, E., Collins, T., Jansen-Winkeln, B., Marescaux, J., Viola, M.G., and Diana, M. (2021). Intraoperative Guidance Using Hyperspectral Imaging: A Review for Surgeons. Diagnostics, 11.","DOI":"10.3390\/diagnostics11112066"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2546819","DOI":"10.1080\/24699322.2025.2546819","article-title":"Surgical hyperspectral imaging: A systematic review","volume":"30","author":"Ali","year":"2025","journal-title":"Comput. Assist. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1093\/bjs\/znad154","article-title":"Intraoperative bowel perfusion assessment methods and their effects on anastomotic leak rates: Meta-analysis","volume":"110","author":"Renna","year":"2023","journal-title":"Br. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.jss.2025.07.051","article-title":"ICG-FA for Anastomotic Leak Prevention During Minimally Invasive Colorectal Surgery: A Meta-analysis","volume":"314","author":"Imran","year":"2025","journal-title":"J. Surg. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1111\/codi.16868","article-title":"Indocyanine green fluorescence angiography could reduce the risk of anastomotic leakage in rectal cancer surgery: A systematic review and meta-analysis of randomized controlled trials","volume":"26","author":"Lucarini","year":"2024","journal-title":"Color. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Xia, S., Wu, W., Luo, L., Ma, L., Yu, L., and Li, Y. (2023). Indocyanine green fluorescence angiography decreases the risk of anastomotic leakage after rectal cancer surgery: A systematic review and meta-analysis. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1157389"},{"key":"ref_7","first-page":"3267217","article-title":"Assessment of Anastomotic Perfusion in Left-Sided Robotic Assisted Colorectal Resection by Indocyanine Green Fluorescence Angiography","volume":"2019","author":"Shapera","year":"2019","journal-title":"Minim. Invasive Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"20201406","DOI":"10.1259\/bjr.20201406","article-title":"Diagnostic and procedural intraoperative ultrasound: Technique, tips and tricks for optimizing results","volume":"94","author":"Lubner","year":"2021","journal-title":"Br. J. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/TA.0000000000004585","article-title":"Diagnosis and management of acute mesenteric ischemia: What you need to know","volume":"99","author":"Tolonen","year":"2025","journal-title":"J. Trauma. Acute Care Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"806","DOI":"10.4240\/wjgs.v13.i8.806","article-title":"Multidisciplinary management of acute mesenteric ischemia: Surgery and endovascular intervention","volume":"13","author":"Sakamoto","year":"2021","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1177\/1538574416639151","article-title":"Management of Acute Mesenteric Ischemia: A Critical Review and Treatment Algorithm","volume":"50","author":"Zhao","year":"2016","journal-title":"Vasc. Endovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"257","DOI":"10.2147\/MDER.S63393","article-title":"Laser speckle contrast imaging for intraoperative assessment of liver microcirculation: A clinical pilot study","volume":"7","author":"Eriksson","year":"2014","journal-title":"Med. Devices"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1007\/s00464-020-07586-5","article-title":"Hyperspectral enhanced reality (HYPER) for anatomical liver resection","volume":"35","author":"Urade","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"6374","DOI":"10.3748\/wjg.v27.i38.6374","article-title":"Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art","volume":"27","author":"Peltrini","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"101545","DOI":"10.1016\/j.suronc.2021.101545","article-title":"Enhancing colorectal anastomotic safety with indocyanine green fluorescence angiography: An update","volume":"43","author":"Pampiglione","year":"2022","journal-title":"Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1007\/s00384-019-03250-0","article-title":"Determination of the transection margin during colorectal resection with hyperspectral imaging (HSI)","volume":"34","author":"Holfert","year":"2019","journal-title":"Int. J. Color. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jss.2020.04.001","article-title":"Hyperspectral Imaging (HSI) in Acute Mesenteric Ischemia to Detect Intestinal Perfusion Deficits","volume":"254","author":"Mehdorn","year":"2020","journal-title":"J. Surg. Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Moulla, Y., Buchloh, D.C., K\u00f6hler, H., Rademacher, S., Denecke, T., Meyer, H.-J., Mehdorn, M., Lange, U.G., Sucher, R., and Seehofer, D. (2021). Hyperspectral Imaging (HSI)-A New Tool to Estimate the Perfusion of Upper Abdominal Organs during Pancreatoduodenectomy. Cancers, 13.","DOI":"10.3390\/cancers13112846"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"67","DOI":"10.21037\/hbsn-20-744","article-title":"Intraoperative reperfusion assessment of human pancreas allografts using hyperspectral imaging (HSI)","volume":"11","author":"Sucher","year":"2022","journal-title":"Hepatobiliary Surg. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Jansen-Winkeln, B., Dvorak, M., K\u00f6hler, H., Maktabi, M., Mehdorn, M., Chalopin, C., Diana, M., Gockel, I., and Barberio, M. (2022). Border Line Definition Using Hyperspectral Imaging in Colorectal Resections. Cancers, 14.","DOI":"10.3390\/cancers14051188"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7794","DOI":"10.1007\/s00464-022-09282-y","article-title":"Video: Clinical evaluation of a laparoscopic hyperspectral imaging system","volume":"36","author":"Pfahl","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"8520","DOI":"10.1007\/s00464-022-09407-3","article-title":"Intraoperative bowel perfusion quantification with hyperspectral imaging: A guidance tool for precision colorectal surgery","volume":"36","author":"Barberio","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Felli, E., Cinelli, L., Bannone, E., Giannone, F., Muttillo, E.M., Barberio, M., Keller, D.S., Rodr\u00edguez-Luna, M.R., Okamoto, N., and Collins, T. (2022). Hyperspectral Imaging in Major Hepatectomies: Preliminary Results from the Ex-Machyna Trial. Cancers, 14.","DOI":"10.3390\/cancers14225591"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3691","DOI":"10.1007\/s00464-023-09874-2","article-title":"In vivo evaluation of a hyperspectral imaging system for minimally invasive surgery (HSI-MIS)","volume":"37","author":"Pfahl","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zimmermann, A., K\u00f6hler, H., Chalopin, C., Jansen-Winkeln, B., Nowotny, R., Sch\u00f6nherr, T., Mehdorn, M., Uttinger, K.L., Thieme, R., and Gockel, I. (2023). The role of intraoperative hyperspectral imaging (HSI) in colon interposition after esophagectomy. BMC Surg., 23.","DOI":"10.1186\/s12893-023-01946-3"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1007\/s00423-024-03497-4","article-title":"Hyperspectral imaging of human liver allografts for prediction of initial graft function","volume":"409","author":"Vogt","year":"2024","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e528","DOI":"10.1097\/AS9.0000000000000528","article-title":"Intraoperative Hyperspectral Imaging Predicts Early Allograft Dysfunction and Overall Survival in Liver Transplantation","volume":"5","author":"Lederer","year":"2024","journal-title":"Ann. Surg. Open"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"010901","DOI":"10.1117\/1.JBO.19.1.010901","article-title":"Medical hyperspectral imaging: A review","volume":"19","author":"Lu","year":"2014","journal-title":"J. Biomed. Opt."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"101699","DOI":"10.1016\/j.media.2020.101699","article-title":"Surgical spectral imaging","volume":"63","author":"Clancy","year":"2020","journal-title":"Med. Image Anal."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"041504","DOI":"10.1063\/5.0240444","article-title":"Advancing hyperspectral imaging and machine learning tools toward clinical adoption in tissue diagnostics: A comprehensive review","volume":"8","author":"Lai","year":"2024","journal-title":"APL Bioeng."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Huang, C.-W., Su, C.-C., Chou, C.-K., Mukundan, A., Karmakar, R., Chen, T.-H., Shukla, P., Gupta, D., and Wang, H.-C. (2025). Software-Based Transformation of White Light Endoscopy Images to Hyperspectral Images for Improved Gastrointestinal Disease Detection. Diagnostics, 15.","DOI":"10.3390\/diagnostics15131664"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"13797","DOI":"10.1038\/s41598-018-32139-1","article-title":"Early identification of esophageal squamous neoplasm by hyperspectral endoscopic imaging","volume":"8","author":"Wu","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","article-title":"Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument","volume":"73","author":"Slim","year":"2003","journal-title":"ANZ J. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1159\/000509304","article-title":"Intraoperative Assessment of Gastric Sleeve Oxygenation Using Hyperspectral Imaging in Esophageal Resection: A Feasibility Study","volume":"37","author":"Schwandner","year":"2021","journal-title":"Visc. Med."},{"key":"ref_35","first-page":"975","article-title":"Laser speckle contrast imaging for intraoperative quantitative assessment of intestinal blood perfusion during colorectal surgery: A prospective pilot study","volume":"33","author":"Kojima","year":"2019","journal-title":"Surg. Endosc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/j.jamcollsurg.2008.01.013","article-title":"Enhanced surgical imaging: Laparoscopic vessel identification and assessment of tissue oxygenation","volume":"206","author":"Crane","year":"2008","journal-title":"J. Am. Coll. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1038\/nrclinonc.2013.123","article-title":"Image-guided cancer surgery using near-infrared fluorescence","volume":"10","author":"Vahrmeijer","year":"2013","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1002\/ijc.33570","article-title":"Novel imaging techniques for intraoperative margin assessment in surgical oncology: A systematic review","volume":"149","author":"Heidkamp","year":"2021","journal-title":"Int. J. Cancer"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1336\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:18:34Z","timestamp":1777457914000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":38,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16091336"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16091336","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]}}}