Golden vision: The potential of yellow enhancement in laparoscopic abdominal surgeries and surgical education

Abstract

Laparoscopic imaging has advanced significantly, with higher resolutions like 4K, and innovative light modes such as narrow band imaging and near-infrared imaging. Recently, yellow enhancement (YE) mode has emerged as a novel tool that enhances the pale-yellow colour of fat into a fluorescent yellow-green, improving contrast without the need for injected dyes. It can be toggled on and off easily during surgery. YE is still under evaluation, but early experience suggests it helps surgeons differentiate anatomical planes and key intra-abdominal structures from surrounding adipose tissue. This is particularly useful in: (1) Dissecting structures surrounded or covered by fat; and (2) operating on patients with obesity, where excess intra-abdominal fat limits visualisation and retraction. By enhancing the visibility of vascular pedicles, ureters, and nerves, YE enables more precise dissections and may reduce the risk of accidental injury. It can also assist less experienced surgeons in identifying important structures, potentially improving efficiency and surgical outcomes. As a training tool, YE may shorten the learning curve, though further study is needed. Overall, YE offers potential benefits in fat-dense surgical fields by improving visualisation, reducing complications, and enhancing patient safety.

Keywords: Laparoscopy; Optical imaging; Obesity; Abdominal; Yellow enhancement; Colorectal surgery; Gynecologic surgical procedures; General surgery; Adhesiolysis; Surgical planes; Minimally invasive surgery; Intraoperative imaging; Surgical training; Fat plane dissection; Image enhanced surgery

Core Tip: Yellow enhancement (YE) mode is an innovative imaging technique in laparoscopic surgery that enhances the contrast between adipose tissue and critical anatomical structures by converting pale-yellow fat into a fluorescent yellow-green hue. This real-time, dye-free modality aids surgeons in identifying surgical planes and vital structures such as vascular pedicles, ureters, and nerves, particularly in patients with obesity. Preliminary findings suggest that YE mode may improve surgical precision, reduce complications, and serve as a valuable tool in surgical training by shortening the learning curve for less experienced surgeons.