Preliminary Experience With Intraoperative Near-infrared Fluorescence Imaging in Percutaneous Sclerotherapy of Soft-Tissue Venous Malformations

Ishikawa, Kosuke; Sasaki, Satoshi; Furukawa, Hiroshi; Nagao, Munenori; Iwasaki, Daisuke; Saito, Noriko; Yamamoto, Yuhei

doi:10.1111/dsu.12152

Cited by 11 publications

(9 citation statements)

References 14 publications

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“…Fluorescence imaging was also applied during percutaneous sclerotherapy of venous malformations, especially in the face and hands, allowing non-invasive assessment of the real-time distribution of sclerosant [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

Evaluating the Development Status of Fluorescence-Guided Surgery (FGS) in Pediatric Surgery Using the Idea, Development, Exploration, Assessment, and Long-Term Study (IDEAL) Framework

2023

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Fluorescence-guided surgery (FGS) is used in many pediatric subspecialties but there are currently no standard guidelines or outcome data. We aimed to assess the current status of FGS in pediatrics using the Idea, Development, Exploration, Assessment, and Long-term study (IDEAL) framework. Clinical papers on FGS in children published from January 2000 to December 2022 were systematically reviewed. The stage of research development was measured considering seven fields of application: biliary tree imaging, vascular perfusion for gastrointestinal procedures, lymphatic flow imaging, tumor resection, urogenital surgery, plastic surgery, and miscellaneous procedures. Fifty-nine articles were selected. For each field of application, the overall IDEAL stage was determined to be 2a for biliary tree imaging (10 publications, 102 cases), 1 for vascular perfusion for gastrointestinal procedures (8 publications, 28 cases), 1 for lymphatic flow imaging (12 publications, 33 cases), 2a for tumor resection (20 publications, 238 cases), 2a for urogenital surgery (9 publications, 197 cases), and 1-2a for plastic surgery (4 publications, 26 cases). One report did not belong to any categories. FGS in children is still in an early phase of adoption and development. We recommend using the IDEAL framework as a guide and suggest developing multicenter studies to define the standard guidelines, effectiveness, and outcomes.

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Section: Resultsmentioning

confidence: 99%

Evaluating the Development Status of Fluorescence-Guided Surgery (FGS) in Pediatric Surgery Using the Idea, Development, Exploration, Assessment, and Long-Term Study (IDEAL) Framework

2023

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“…Most ICG-FA indications used a peripheral vein injection ( n = 29; 45%). However, chylothorax and lymphatic/venous procedures ( 15 , 30 , 38 , 40 , 42 , 47 , 50 , 51 , 56 , 57 , 61 ) required subcutaneous ICG injections, and varicocelectomies ( 22 , 24 ) needed direct injections into the ipsilateral testicle. Indocyanine green dose and injection timing varied according to surgical teams and indications and were adequately reported in only 29/64 (45%) studies.…”

Section: Resultsmentioning

confidence: 99%

“…In pediatric cardiac surgery, ICG-FA was used for congenital cardiac surgeries ( n = 3) ( 45 , 52 , 68 ) and post-operative chylothorax ( n = 2) ( 40 , 61 ). Reported indications in pediatric plastic surgery were lymphatic and venous malformations ( n = 8) ( 17 , 21 , 30 , 38 , 39 , 42 , 50 , 57 ) and tissue perfusion ( n = 3) ( 33 , 46 , 65 ). Orthopedics indications were rare and included trauma surgeries ( n = 2) ( 19 , 20 ) and rotationplasty for patients with femoral sarcoma ( n = 1) ( 11 ).…”

Section: Resultsmentioning

confidence: 99%

“…Another study has successfully detected hepatoblastoma pulmonary metastases of 1.2 mm at a dept of 6 mm from the lung surface ( 59 ). For lymphatic imaging, authors have also reported a limit of <1–2 cm in the depth of lymphatic vessels visualization ( 38 , 42 , 56 ). While most fluorescence lymphatic imaging were successful ( 15 ), ICG-FA failed to demonstrate the chylous leak in a patient who underwent a lymphatic imaging for a postoperative chylothorax.…”

Section: Resultsmentioning

confidence: 99%

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The Use of Indocyanine Green Fluorescence Angiography in Pediatric Surgery: A Systematic Review and Narrative Analysis

et al. 2021

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Purpose: Indocyanine green fluorescence angiography (ICG-FA) is a validated non-invasive imaging technique used to assess tissue vascularization and guide intraoperative decisions in many surgical fields including plastic surgery, neurosurgery, and general surgery. While this technology is well-established in adult surgery, it remains sparsely used in pediatric surgery. Our aim was to systematically review and provide an overview of all available evidence on the perioperative use of indocyanine green fluorescence angiography in pediatric surgical patients.Methods: We conducted a systematic review with narrative synthesis in conformity with the PRISMA guidelines using PubMed, Medline, All EBM Reviews, EMBASE, PsycINFO, and CINAHL COMPLETE databases to identify articles describing the perioperative use of ICG-FA in pediatric patients. Two independent authors screened all included articles for eligibility and inclusion criteria. We extracted data on study design, demographics, surgical indications, indocyanine green dose, and perioperative outcomes. We developed a risk of bias assessment tool to evaluate the methodological quality of included studies.Results: Of 1,031 articles retrieved, a total of 64 articles published between 2003 and 2020 were included reporting on 664 pediatric patients. Most articles were case reports and case series (n = 36; 56%). No adverse events related to ICG-FA were reported in the included articles. Risk of bias was high. We did not conduct a meta-analysis given the heterogeneous nature of the populations, interventions, and outcome measures. A narrative synthesis is presented.Conclusion: Indocyanine green fluorescence angiography is a safe imaging technology and its use is increasing rapidly in pediatric surgical specialties. However, the quality of evidence supporting this trend currently appears low. Case-control and randomized trials are needed to determine the adequate pediatric dose and to confirm the potential benefits of ICG-FA in pediatric surgical patients.Systematic Review Registration: This study was registered on Prospero a priori, identifier: CRD42020151981.

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“…This concentration is more than 100 times less than the peak fluorescence intensity of ICG in some in-vivo models (17). Second, our system’s limit of detection was lower than doses given in clinical trials (18, 19). Lastly, and most importantly, the SPIIF was able to detect NIR signal from tissues in both the laboratory and clinical setting, which proves to be its most valuable attribute.…”

Section: Discussionmentioning

confidence: 96%

Small Portable Interchangeable Imager of Fluorescence for Fluorescence Guided Surgery and Research

Okusanya

Madajewski

Segal

et al. 2013

Technol Cancer Res Treat

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Fluorescence guided surgery (FGS) is a developing field of surgical and oncologic research. Practically, FGS has shown useful applications in urologic surgery, benign biliary surgery, colorectal cancer liver metastasis resection, and ovarian cancer debulking. Most notably in in cancer surgery, FGS allows for the clear delineation of cancerous tissue from benign tissue. FGS requires the utilization of a fluorescent contrast agent and an intraoperative fluorescence imaging device (IFID). Currently available IFIDs are expensive, unable to work with multiple fluorophores, and can be cumbersome. This study aims to describe the development and utility of a small, cost-efficient, and interchangeable IFID made from commercially available components. Extensive research was done to design and construct a light-weight, portable, and cost-effective IFID. We researched the capabilities, size, and cost of several camera types and eventually decided on a near-infrared (NIR) charged couple device (CCD) camera for its overall profile. The small portable interchangeable imager of fluorescence (SPIIF) is a “scout” IFID system for FGS. The main components of the SPIIF are a NIR CCD camera with an articulating light filter. These components and a LED light source with an attached heat sink are mounted on a small metal platform. The system is connected to a laptop by a USB 2.0 cable. Pixielink © software on the laptop runs the system by controlling exposure time, gain, and image capture. After developing the system, we evaluated its utility as an IFID. The system weighs less than two pounds and can cover a large area. Due to its small size, it is easily made sterile by covering it with any sterile plastic sheet. To determine the system’s ability to detect fluorescent signal, we used the SPIIF to detect indocyanine green under ex and in-vivo conditions and fluorescein under ex-vivo conditions. We found the SPIIF was able to detect both ICG and fluorescein under different depths of a semi-opaque colloid. Second, we found that a concentration as low as 0.5 g/ml of indocyanine green dissolved in plasma was detectable. Lastly, in a murine and human cancer model, the SPIIF was able to detect indocyanine green signal within tumors and generate a signal-to-background ratio (SBR) of 3.75. This study shows that a low-cost IFID can be made from commercially available parts. Second, this IFID is capable of in and ex-vivo detection of multiple fluorophores without sacrificing its small size or favorable ergonomics.

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Preliminary Experience With Intraoperative Near-infrared Fluorescence Imaging in Percutaneous Sclerotherapy of Soft-Tissue Venous Malformations

Abstract: NIR fluorescence imaging with ICG can be a useful additional monitor for percutaneous sclerotherapy of venous malformations, especially in the face and hands, enabling noninvasive assessment of real-time spread of sclerosant.

Cited by 11 publications

References 14 publications

Evaluating the Development Status of Fluorescence-Guided Surgery (FGS) in Pediatric Surgery Using the Idea, Development, Exploration, Assessment, and Long-Term Study (IDEAL) Framework

Evaluating the Development Status of Fluorescence-Guided Surgery (FGS) in Pediatric Surgery Using the Idea, Development, Exploration, Assessment, and Long-Term Study (IDEAL) Framework

The Use of Indocyanine Green Fluorescence Angiography in Pediatric Surgery: A Systematic Review and Narrative Analysis

Small Portable Interchangeable Imager of Fluorescence for Fluorescence Guided Surgery and Research

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