Usefulness of intraoperative fluorescence imaging to evaluate local anatomy in hepatobiliary surgery

Mitsuhashi, Noboru; Kimura, Fumio; Shimizu, Hiroaki; Imamaki, Mizuho; Yoshidome, Hiroyuki; Ohtsuka, Masayuki; Kato, Atsushi; Yoshitomi, Hideyuki; Nozawa, Satoshi; Furukawa, Katsunori; Takeuchi, Dan; Takayashiki, Tsukasa; Suda, Kosuke; Igarashi, Tatsuo; Miyazaki, Masaru

doi:10.1007/s00534-007-1307-5

Cited by 137 publications

(99 citation statements)

References 11 publications

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“…Possible applications of this technique during hepatopancreatobiliary surgery include tumor detection in liver and pancreas resections and real-time imaging of intra-and extrahepatic bile ducts (and branches) of hepatic, cystic, pancreatic, gastroduodenal, and pancreatoduodenal arteries. [10][11][12] Moreover, fluorescence imaging could be performed to detect bile leakage during open and laparoscopic partial liver resections. This complication after hepatectomy occurs in approximately 8% of all patients undergoing partial liver resection and is associated with greater postoperative mortality and healthcare costs.…”

Section: Discussionmentioning

confidence: 99%

Near-Infrared Fluorescence Laparoscopy of the Cystic Duct and Artery in Pigs: Performance of a Preclinical Dye

Schols

Lodewick

Bouvy

et al. 2014

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Background: Near-infrared fluorescence laparoscopy after intravenous indocyanine green (ICG) administration has been proposed as a promising surgical imaging technique for real-time visualization of the extrahepatic bile ducts and arteries in clinical laparoscopic cholecystectomies. However, optimization of this new technique with respect to the imaging system combined with the fluorophore is desirable. The performance of a preclinical near-infrared dye, CW800-CA, was compared with that of ICG for near-infrared fluorescence laparoscopy of the cystic duct and artery in pigs. Materials and Methods: Laparoscopic cholecystectomy was performed in six pigs (average weight, 35 kg) using a commercially available laparoscopic fluorescence imaging system. The fluorophores CW800-CA and ICG (both 800 nm fluorescent dyes) were administered by intravenous injection in four and two pigs, respectively. CW800-CA was administered in three different doses (consecutively 0.25, 1, and 3 mg); ICG was intravenously injected (2.5 mg) for comparison. Intraoperative recognition of the biliary structures was recorded at set time points. The target-to-background ratio was determined to quantify the fluorescence signal of the designated tissues.

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Section: Discussionmentioning

confidence: 99%

Near-Infrared Fluorescence Laparoscopy of the Cystic Duct and Artery in Pigs: Performance of a Preclinical Dye

Schols

Lodewick

Bouvy

et al. 2014

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…Previous studies reported that the permeation limit of near-infrared light in human tissue is up to 1 cm. 15,33,34 Therefore, the utility of this technique is limited to superficial hepatic tumors. However, small lesions at the hepatic surface are likely to be missed by other imaging methods, such as CT, MRI, or US, because of partial volume effects or poor near-field resolution; whereas those conventional modalities are better at detecting deep hepatic lesions.…”

Section: Discussionmentioning

confidence: 99%

Real‐time detection of hepatic micrometastases from pancreatic cancer by intraoperative fluorescence imaging

Yokoyama

Otani

Hashidate

et al. 2011

Cancer

105

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BACKGROUND: Recently, a highly sensitive fluorescent imaging technique was developed for the real-time identification of hepatic tumors. The authors applied this procedure for the intraoperative detection of radiographically occult hepatic micrometastases from pancreatic cancer. METHODS: Forty-nine consecutive patients with pancreatic cancer who underwent surgical intervention were examined. Preoperative clinical images had not revealed any hepatic metastases. On the day before surgery, indocyanine green was injected intravenously. During the operation, the liver was observed with a near-infrared camera system, and abnormal fluorescent foci were examined by frozen-section histology. The patients with hepatic micrometastases were judged to have unresectable disease and underwent only palliative surgery followed by systemic chemotherapy using gemcitabine. RESULTS: Abnormal hepatic fluorescence at least 1.5 mm in greatest dimension without any apparent tumor was observed in 13 patients. Among them, histologic examination confirmed micrometastases in 8 of 49 patients (16%). All patients with hepatic micrometastases had clinical T3 or T4 disease and high serum CA19-9 levels (P ¼ .042). On follow-up computed tomography images that were obtained within 6 months after surgery, the patients with hepatic micrometastases manifested hepatic overt metastases (7 of 8 patients; 88%) more frequently than the patients without hepatic micrometastases (4 of 41 patients; 10%; P < .001). Regardless of histologic confirmation, the positive predictive value of abnormal fluorescence for the manifestation of hepatic relapse within 6 months was 77% (10 of 13 patients), and the negative predictive value was 97% (35 of 36 patients). CONCLUSIONS: Indocyanine green-fluorescent imaging can detect hepatic micrometastases of pancreatic cancer during surgery. The hepatic micrometastases seem to have an adverse clinical impact identical to that of evident distant metastases. Cancer 2012;118:2813-

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“…Fluorescence cannot only be used to mark sites of pathology for resection but also to mark sensitive areas for the surgeon to avoid [5][6][7][8][9]. Increased availability of specific fluorescent probes which delineate ducts, tissues and/or molecular expression will continue, and these will gradually find successful applications in surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Optimization of fluorescent imaging in the operating room through pulsed acquisition and gating to ambient background cycling

Sexton

Zhao

Davis

et al. 2017

Biomed. Opt. Express

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Abstract:The design of fluorescence imaging instruments for surgical guidance is rapidly evolving, and a key issue is to efficiently capture signals with high ambient room lighting. Here, we introduce a novel time-gated approach to fluorescence imaging synchronizing acquisition to the 120 Hz light of the room, with pulsed LED excitation and gated ICCD detection. It is shown that under bright ambient room light this technique allows for the detection of physiologically relevant nanomolar fluorophore concentrations, and in particular reduces the light fluctuations present from the room lights, making low concentration measurements more reliable. This is particularly relevant for the light bands near 700nm that are more dominated by ambient lights.

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Usefulness of intraoperative fluorescence imaging to evaluate local anatomy in hepatobiliary surgery

Abstract: Intraoperative fluorescence imaging in hepatobiliary surgery facilitates better understanding of the anatomy of arteries, the portal vein, and bile ducts.

Cited by 137 publications

References 11 publications

Near-Infrared Fluorescence Laparoscopy of the Cystic Duct and Artery in Pigs: Performance of a Preclinical Dye

Near-Infrared Fluorescence Laparoscopy of the Cystic Duct and Artery in Pigs: Performance of a Preclinical Dye

Real‐time detection of hepatic micrometastases from pancreatic cancer by intraoperative fluorescence imaging

Optimization of fluorescent imaging in the operating room through pulsed acquisition and gating to ambient background cycling

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