Advancing Precision in Abdominal Oncologic Surgery: Real-Time Fluorescence Guidance and Emerging Assistive Exoskeleton Technologies

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Abstract
Real-time fluorescence-guided surgery has become an increasingly important intraoperative tool in abdominal oncologic surgery, providing surgeons with dynamic visual information that supports critical decision-making during complex procedures. This review analyzes current evidence on fluorescence-guided imaging techniques, with particular emphasis on near-infrared fluorescence using indocyanine green and tumor-targeted probes, and explores their potential integration with assistive surgical technologies such as exoskeleton-based support systems. The available literature demonstrates that fluorescence guidance plays a central role in margin refinement, perfusion assessment, identification of critical anatomy, and detection of occult disease, thereby enhancing intraoperative precision and safety. Furthermore, recent studies highlight the importance of visualization workflows and interface design, underscoring the need to consider how surgeons interpret and act upon fluorescence-derived information in real time. From a workflow-oriented perspective, the combination of advanced imaging and biomechanical support may contribute to more consistent execution of fluorescence-informed decisions, particularly during prolonged and technically demanding oncologic procedures. This review contextualizes these findings within international surgical practice, with specific relevance to educational and clinical settings in Mexico, Colombia, and Ecuador. Overall, the evidence supports a holistic view of precision surgery in which fluorescence-guided imaging and assistive technologies function synergistically to enhance surgical performance, decision-making, and training in abdominal oncologic surgery.