Fluorescent-Guided Liver Surgery: Paul Brousse Experiences and Perspective

Indocyanine Green Fluorescence Imaging-Guided Surgery in Primary and Metastatic Liver Tumors

“…To date, the role of ICG-FI in cholangiocarcinoma has been described in very few cases. 7,18,20 In contrast with some authors, 20 and in agreement with others, 7,18 our case showed a hypofluorescent pattern. Indeed, hepatocytes accumulating ICG are usually absent in this tumor; thus, cholangiocarcinoma appears as a hypofluorescent area surrounded by a hyperfluorescent ring.…”

“…Like cholangiocarcinoma, metastatic liver tumors also appear as hypofluorescent nodules because they do not accumulate ICG. 14,20,21,24,30 The characteristic hyperfluorescent rim surrounding the tumor is believed to be constituted by compressed hepatocytes, with increased ductular transformation and severe disorders of bile excretion. 32…”

“…14,18 This feature, combined with its rapid clearance from the circulation, makes ICG a potentially good probe for the NIR-FI of solid tumors, including liver tumors. 19-21 In addition, it could be useful to detect superficial or subcapsular liver tumors that frequently go undiagnosed by conventional imaging. 22,23…”

Fluorescence‐Guided Surgery in the Combined Treatment of Peritoneal Carcinomatosis from Colorectal Cancer: Preliminary Results and Considerations

“…Indocyanine green (ICG), a near‐infrared contrast agent becoming fluorescent if excited by light with a wavelength of 800–900 nm, has been recently proposed for FI because of its special affinity for cancer tissue [21, 22]. Bound to serum proteins, ICG works as a macromolecule permeating endothelial fissures and is retained in cancer tissue because of impaired lymphatic drainage [enhanced permeability and retention (EPR)] from the lesion [23, 24]. Intravenously injected ICG is removed from the circulation and remains in the lesion, allowing a high signal‐to‐background ratio, at a depth of few millimeters within the tissue itself [25].…”

Use of indocyanine green fluorescence during hepatobiliary surgery

“…Indocyanine green (ICG) is a water-soluble dye that emits wavelengths in serum at 778 and 830 nm, respectively 7 . ICG binds to plasma proteins and is then rapidly taken up by hepatocytes, thus quickly disappearing from the bloodstream (half-life ~3-4 minutes) and then secreted into the bile without metabolization 8,9 .This hepatocytic uptake can be visualized by near-infrared fluorescence imaging camera which allows detection of hepatocellular (tumor fluorescence) and non-hepatocellular tumors (peri-tumoral fluorescence) along with metastatic tumors [10][11][12][13][14][15][16] . In addition, it helps to delineate extra hepatic biliary radicals during difficult cholecystectomy helping to prevent bile duct injury.…”