Real-time intra-operative near-infrared fluorescence identification of the extrahepatic bile ducts using clinically available contrast agents

Matsui, Aya; Tanaka, Eiichi; Choi, Hak; Winer, Joshua H.; Kianzad, Vida; Gioux, Sylvain; Laurence, Rita G.; Frangioni, John V.

doi:10.1016/j.surg.2009.12.004

Cited by 110 publications

(100 citation statements)

References 23 publications

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“…28 Available within this range is methylene blue, a weakly fluorescent visible blue dye that is currently approved for use as a visible stain for lymph node mapping. 2 While some research groups have investigated its use as a far-red fluorophore, 29 the low fluorescence yield and lack of any functional groups for addition of ligands have limited its use in clinical applications. ICG is the only approved fluorophore in the NIR-window and several imagers have been designed and commercially launched to allow ICG guidance in surgery for blood flow assessment, [30][31][32] hepatic function assessment, 33,34 and vessel patency and perfusion evaluation especially in reconstructive 35,36 and bypass surgeries.…”

Section: Introductionmentioning

confidence: 99%

Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging

et al. 2016

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Abstract. There is growing interest in using fluorescence imaging instruments to guide surgery, and the leading options for open-field imaging are reviewed here. While the clinical fluorescence-guided surgery (FGS) field has been focused predominantly on indocyanine green (ICG) imaging, there is accelerated development of more specific molecular tracers. These agents should help advance new indications for which FGS presents a paradigm shift in how molecular information is provided for resection decisions. There has been a steady growth in commercially marketed FGS systems, each with their own differentiated performance characteristics and specifications. A set of desirable criteria is presented to guide the evaluation of instruments, including: (i) real-time overlay of white-light and fluorescence images, (ii) operation within ambient room lighting, (iii) nanomolar-level sensitivity, (iv) quantitative capabilities, (v) simultaneous multiple fluorophore imaging, and (vi) ergonomic utility for open surgery. In this review, United States Food and Drug Administration 510(k) cleared commercial systems and some leading premarket FGS research systems were evaluated to illustrate the continual increase in this performance feature base. Generally, the systems designed for ICG-only imaging have sufficient sensitivity to ICG, but a fraction of the other desired features listed above, with both lower sensitivity and dynamic range. In comparison, the emerging research systems targeted for use with molecular agents have unique capabilities that will be essential for successful clinical imaging studies with low-concentration agents or where superior rejection of ambient light is needed. There is no perfect imaging system, but the feature differences among them are important differentiators in their utility, as outlined in the data and tables here. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Section: Introductionmentioning

confidence: 99%

Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging

et al. 2016

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“…Because ICG is almost exclusively excreted into the bile, it can also be used for intraoperative NIR fluorescence exploration of the biliary anatomy [29,30,31]. This can be useful in patients with a difficult laparoscopic cholecystectomy, due to an aberrant biliary anatomy or an acute cholecystitis, for example.…”

Section: Introductionmentioning

confidence: 99%

Near-Infrared Fluorescence Imaging in Patients Undergoing Pancreaticoduodenectomy

Hutteman¹,

Vorst²,

Mieog³

et al. 2011

Eur Surg Res

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Background: Intraoperative visualization of pancreatic tumors has the potential to improve radical resection rates. Intraoperative visualization of the common bile duct and bile duct anastomoses could be of added value. In this study, we explored the use of indocyanine green (ICG) for these applications and attempted to optimize injection timing and dose. Methods: Eight patients undergoing a pancreaticoduodenectomy were injected intravenously with 5 or 10 mg ICG. During and after injection, the pancreas, tumor, common bile duct and surrounding organs were imaged in real time using the Mini-FLARE™ near-infrared (NIR) imaging system. Results: No clear tumor-to-pancreas contrast was observed, except for incidental contrast in 1 patient. The common bile duct was clearly visualized using NIR fluorescence, within 10 min after injection, with a maximal contrast between 30 and 90 min after injection. Patency of biliary anastomoses could be visualized due to biliary excretion of ICG. Conclusion: No useful tumor demarcation could be visualized in pancreatic cancer patients after intravenous injection of ICG. However, the common bile duct and biliary anastomoses were clearly visualized during the observation period. Therefore, these imaging strategies could be beneficial during biliary surgery in cases where the surgical anatomy is aberrant or difficult to identify.

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“…From our experience in IGS, the benefit of having co-registration between the color image and a bright, background-free NIR fluorescence signal is of paramount importance since it provides both anatomical landmarks and clear fluorescence localization simultaneously to the surgeon. In addition, there is a growing clinical interest in the field for using either a 700-nm dye (e.g., MB), or an 800-nm dye (e.g., ICG) or both simultaneously 42,43 that requires one to incorporate dual NIR channel capability on a single imaging system. Together, all these limitations demand the development of a custom endoscopic imaging system optimized for operation in the NIR wavelengths.…”

Section: Introductionmentioning

confidence: 99%

“…The image sensor should be highly sensitive, with a high quantum yield for fast NIR imaging, while allowing minimal camera head footprint for ergonomic use in minimally invasive surgery. Previous approaches have relied on the use of higher sensitivity cameras (such as EMCCD) or an image intensifier to improve the detection sensitivity 42,43 but pose significant challenges in terms of integration within the clinical workflow and/or noise and resolution degradation. 45 In this study, we describe the design, characterization, and validation of a clinically compatible endoscopic imaging system optimized for simultaneous color and NIR fluorescence imaging.…”

Section: Introductionmentioning

confidence: 99%

Design and characterization of an optimized simultaneous color and near-infrared fluorescence rigid endoscopic imaging system

et al. 2013

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Abstract. We report the design, characterization, and validation of an optimized simultaneous color and near-infrared (NIR) fluorescence rigid endoscopic imaging system for minimally invasive surgery. This system is optimized for illumination and collection of NIR wavelengths allowing the simultaneous acquisition of both color and NIR fluorescence at frame rates higher than 6.8 fps with high sensitivity. The system employs a custom 10-mm diameter rigid endoscope optimized for NIR transmission. A dual-channel light source compatible with the constraints of an endoscope was built and includes a plasma source for white light illumination and NIR laser diodes for fluorescence excitation. A prism-based 2-CCD camera was customized for simultaneous color and NIR detection with a highly efficient filtration scheme for fluorescence imaging of both 700-and 800-nm emission dyes. The performance characterization studies indicate that the endoscope can efficiently detect fluorescence signal from both indocyanine green and methylene blue in dimethyl sulfoxide at the concentrations of 100 to 185 nM depending on the background optical properties. Finally, we performed the validation of this imaging system in vivo during a minimally invasive procedure for thoracic sentinel lymph node mapping in a porcine model.

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Real-time intra-operative near-infrared fluorescence identification of the extrahepatic bile ducts using clinically available contrast agents

Cited by 110 publications

References 23 publications

Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging

Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging

Near-Infrared Fluorescence Imaging in Patients Undergoing Pancreaticoduodenectomy

Design and characterization of an optimized simultaneous color and near-infrared fluorescence rigid endoscopic imaging system

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