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Fortuna L, Buccianti S, Risaliti M, Matarazzo F, Agostini C, Ringressi MN, Taddei A, Bartolini I, Grazi GL. Indocyanine Green and Hepatobiliary Surgery: An Overview of the Current Literature. J Laparoendosc Adv Surg Tech A 2024; 34:921-931. [PMID: 39167475 DOI: 10.1089/lap.2024.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
Indocyanine green (ICG) is an inert polypeptide that almost totally binds to high molecular weight plasma proteins; it is cleared by the hepatocytes and directly excreted into the bile with a half-life of about 3-5 minutes. Specific systems are required to see fluorescent images. The use of this dye has been reported in different surgical specialties, and the applications in hepatobiliary surgery are widening. Being firstly used to evaluate the preoperative liver function, intra- and postoperative dynamic checking of hepatic activity has been reported and integrated within perioperative protocols allowing a tailored treatment allocation. Intravenous injection (IV) or injection into the gallbladder can ease difficult cholecystectomy. Biliary leakage detection could be enhanced by IV ICG injection. Although with some contrasting results, the use of ICG for both delineating the limits of the resection and tumor-enhanced visualization was demonstrated to improve short- and long-term outcomes. Although the lack of strong evidence still precludes the introduction of this tool in clinical practice, it harbors great potential in liver surgery.
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Affiliation(s)
- Laura Fortuna
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Simone Buccianti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Matteo Risaliti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Francesco Matarazzo
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Carlotta Agostini
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | - Antonio Taddei
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Ilenia Bartolini
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Gian Luca Grazi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Naderi PM, Zargoosh K, Qandalee M, Firuzi O, Behmadi H, Hosseinkhani S, Ghafary SM, Durán-Valle CJ, López-Coca IM. A Fluorescent Furan-based Probe with Protected Functional Groups for Highly Selective and Non-Toxic Imaging of HT-29 Cancer Cells and 4T1 Tumors. Chempluschem 2024; 89:e202400095. [PMID: 38787798 DOI: 10.1002/cplu.202400095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 05/26/2024]
Abstract
Most of the previously reported fluorescent organic probes for cancer cell and tumor imaging have significant limitations including chemical toxicity, structural instability, low Stokes shift value, and the inability for selective accumulations in tumors during in vivo imaging. To overcome the mentioned challenges, we synthesized the fluorescent probes with protected polar functional groups to enhance the non-toxicity nature and increase the selectivity toward tumors. In addition, the structural rigidity of the fluorescent probes was increased by embedding aromatic rings in the probe structure. This issue enables us to obtain ultrabright cell images due to enhanced fluorescence quantum yield (ΦFL) values. After synthesis and spectral characterizations, the applicability of two furan-based and imidazole-based fluorescent probes ( abbreviated as DCPEF and DBPPI, respectively) was investigated for ultrabright in vitro and in vivo imaging of cancer cells. The probe DCPEF shows the ΦFL value of 0.946 and the Stocks shift of 86 nm. In addition, probe DBPPI offers the ΦFL value of 0.400 and a Stocks shift of 150 nm. The MTT colorimetric cytotoxicity assay showed that probe DCPEF has minimal effects against HT-29 (cancer) and Vero (normal) cells. The probe DCPEF produced ultrabright fluorescence images from HT-29 cells. In addition, in vivo imaging of cancer cells showed that probe DCPEF selectively accumulates in the 4T1 tumor in mice. The spectral and chemical stability, minimal cytotoxicity, significant Stokes shift, and high degree of selectivity for tumor cells during in vivo imaging make DCPEF an appropriate candidate to be used as a standard probe for cancer cell imaging.
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Affiliation(s)
- Parisa Mehdizadeh Naderi
- Department of Chemistry, Isfahan University of Technology, Isfahan, 84156-83111, Islamic Republic of Iran
| | - Kiomars Zargoosh
- Department of Chemistry, Isfahan University of Technology, Isfahan, 84156-83111, Islamic Republic of Iran
| | - Mohammad Qandalee
- Department of Basic Sciences, Garmsar Branch, Islamic Azad University, Garmsar, 3581631167, Islamic Republic of Iran
| | - Omidreza Firuzi
- Medicinal and Natural Products Chemistry Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Hossein Behmadi
- Department of Chemistry, Mashhad Branch, Islamic Azad University, Mashhad, Islamic Republic of Iran
| | - Saman Hosseinkhani
- Department of Biochemistry, Faculty of Biological Science, Tarbiat Modares University, Tehran, Islamic Republic of Iran
| | - Soroush Moasses Ghafary
- Department of Nanobiotechnology, Faculty of Biological Science, Tarbiat Modares University, Tehran, Islamic Republic of Iran
| | - Carlos J Durán-Valle
- IACYS, Department of Organic and Inorganic Chemistry, Faculty of Sciences, Universidad de Extremadura, Badajoz, 06006, Spain
| | - Ignacio M López-Coca
- INTERRA, Department of Organic and Inorganic Chemistry, School of Technology, Universidad de Extremadura, Cáceres - 10003, Spain
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Goto T, Noguchi Y, Linares I, Mazilescu L, Nogueira E, Hobeika C, Ray S, Parmentier C, Ganesh S, Peranantharuban J, Chan HH, Reichman T, Selzner N, Selzner M. Indocyanine green fluorescence quantification during normothermic ex situ perfusion for the assessment of porcine liver grafts after circulatory death. Liver Transpl 2024; 30:907-917. [PMID: 38869990 PMCID: PMC11332378 DOI: 10.1097/lvt.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/25/2024] [Indexed: 06/15/2024]
Abstract
Current graft evaluation during normothermic ex situ liver perfusion lacks real-time parameters for predicting posttransplant hepatocyte and biliary function. Indocyanine green (ICG) imaging has been widely used in liver surgery, enabling the visualization of hepatic uptake and excretion through bile using near-infrared light. In this research, porcine livers under various ischemic conditions were examined during a 5-hour normothermic ex situ liver perfusion procedure, introducing ICG at 1 hour through the hepatic artery. These conditions included livers from heart-beating donors, donation after circulatory death (DCD) with warm ischemic durations of 60 minutes (DCD60) and 120 minutes (DCD120), as well as interventions utilizing tissue plasminogen activator in DCD120 cases (each n = 5). Distinct hepatic fluorescence patterns correlated with different degrees of ischemic injury ( p = 0.01). Low ICG uptake in the parenchyma (less than 40% of maximum intensity) was more prevalent in DCD120 (21.4%) compared to heart-beating donors (6.2%, p = 0.06) and DCD60 (3.0%, p = 0.02). Moreover, ICG clearance from 60 minutes to 240 minutes was significantly higher in heart-beating donors (69.3%) than in DCD60 (17.5%, p < 0.001) and DCD120 (32.1%, p = 0.01). Furthermore, thrombolytic intervention using tissue plasminogen activator in DCD120 resulted in noteworthy outcomes, including significantly reduced ALP levels ( p = 0.04) and improved ICG clearance ( p = 0.02) with a trend toward mitigating fibrin deposition similar to DCD60, as well as enhancements in bile production ( p = 0.09). In conclusion, ICG fluorescence imaging during normothermic ex situ liver perfusion provides real-time classification of hepatic vascular and biliary injuries, offering valuable insights for the more accurate selection and postintervention evaluation of marginal livers in transplantation.
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Affiliation(s)
- Toru Goto
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Divisions of Hepato-biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Noguchi
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Linares
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Laura Mazilescu
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Emmanuel Nogueira
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Christian Hobeika
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Samrat Ray
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Catherine Parmentier
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sujani Ganesh
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jathuya Peranantharuban
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Harley H.L. Chan
- TECHNA Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Trevor Reichman
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Nazia Selzner
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Markus Selzner
- Department of Surgery, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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4
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Kato T, Imamura M, Kyuno D, Kimura Y, Kukita K, Murakami T, Yoshida E, Mizuguchi T, Takemasa I. Impact of Infrared Indocyanine Green Fluorescence imaging-guided Laparoscopic Hepatectomy on Securing the Resection Margin for Colorectal Liver Metastasis. Surg Laparosc Endosc Percutan Tech 2024:00129689-990000000-00265. [PMID: 39183534 DOI: 10.1097/sle.0000000000001320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/01/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Laparoscopic hepatectomy for colorectal liver metastases (CRLM) is performed worldwide. However, owing to a lack of palpatory information and difficulties associated with accurate intraoperative ultrasonographic diagnosis, the tumor may be exposed at the hepatic transection margin. This study aimed to investigate the pathological significance of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG)-guided laparoscopic hepatectomy and determine its usefulness in securing the resection margin for CRLMs. METHODS Fifty-nine patients who underwent laparoscopic hepatectomy for CRLM using NIR fluorescence imaging between February 2017 and June 2021 at Sapporo Medical University Hospital were included. Generally, all patients received intravenous ICG (2.5 mg/body) as a fluorescence agent 1 to 2 days before surgery. During the surgical procedure, real-time NIR fluorescence imaging was repeatedly performed to assess the surgical margins. RESULTS Of the 94 tumors in 59 patients, laparoscopic NIR fluorescence imaging identified 56 tumors (59.6%) on the liver surface. Pathological analysis indicated clear margins in 96.6% (57/59) of patients. Examination of paraffin-embedded sections, which were successful in only 20 of 94 cases (21.3%), revealed that there were no tumor cells positive for NIR fluorescence, and the median distance of the continuous fluorescent signal from the tumor margin was 1.074 mm. CONCLUSIONS We demonstrated a high R0 rate using NIR fluorescence-guided hepatectomy. This technique has the potential to improve intraoperative tumor identification and tumor margin assurance and reduce the rate of positive resection margins in patients with CRLMs.
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Affiliation(s)
- Toru Kato
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Hokkaido, Japan
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Zajac J, Liu A, Hassan S, Gibson A. Mechanisms of delayed indocyanine green fluorescence and applications to clinical disease processes. Surgery 2024; 176:386-395. [PMID: 38749795 PMCID: PMC11246809 DOI: 10.1016/j.surg.2024.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/15/2024] [Accepted: 03/28/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Delayed indocyanine green fluorescence imaging is under investigation in various clinical disease processes. Understanding the mechanisms of indocyanine green accumulation and retention is essential to correctly interpreting and analyzing imaging data. The purpose of this scoping review was to synthesize what is known about the mechanism of indocyanine green retention at the cellular level to better understand the clinical nuances of delayed indocyanine green imaging and identify critical gaps in our knowledge to guide future studies. METHODS We performed a scoping review of 7,087 citations after performing database searches of PubMed, Scopus, the Cochrane Library, and the Web of Science Core Collection electronic databases. Studies were eligible for inclusion if they were peer-reviewed original research discussing the mechanism of indocyanine green retention in the results section in disease processes involving inflammation and/or necrosis, including cancer, and were available in English. Data were extracted using Covidence software. RESULTS Eighty-nine studies were included in the final analysis. Several features of indocyanine green retention were identified. CONCLUSION We identified several mechanistic features involved in indocyanine green accumulation in diseased tissue that overall had distinct mechanisms of indocyanine green retention in tumors, nontumor inflammation, and necrosis. Our study also reveals new insights on how inflammatory infiltrate influences indocyanine green fluorescence imaging. These findings are noteworthy because they add to our understanding of how fluorescence-guided surgery may be optimized based on the pathology of interest via specific indocyanine green dosing and timing of image acquisition.
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Affiliation(s)
- Jocelyn Zajac
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Aiping Liu
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sameeha Hassan
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Angela Gibson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Rietbergen DDD, Buckle T, Slof LJ, van Meerbeek MP, de Korne CM, Welling MM, van Oosterom MN, Bauwens K, Roestenberg M, Kloetzl J, van Leeuwen FWB. hHEPATO-Cy5, a Bimodal Tracer for Image-Guided Hepatobiliary Surgery. J Nucl Med 2024; 65:1301-1306. [PMID: 39025649 DOI: 10.2967/jnumed.123.266715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/28/2024] [Indexed: 07/20/2024] Open
Abstract
Liver cancer is a leading cause of cancer deaths worldwide. Surgical resection of superficial hepatic lesions is increasingly guided by the disrupted bile excretion of the fluorescent dye indocyanine green (ICG). To extend this approach to deeper lesions, a dedicated bimodal tracer that facilitates both fluorescence guidance and radioguidance was developed. Methods: A tracer comprising a methylated cyanine-5 (Cy5) fluorescent dye and a mercaptoacetyltriserine chelate (hHEPATO-Cy5) was synthesized and characterized. Cellular uptake and excretion were evaluated in hepatocyte cultures (2-dimensional culture and in vitro lesion model), using a fluorescent bile salt, MitoTracker dye, and methylated Cy5 as a control. After radiolabeling, the pharmacokinetics of 99mTc-hHEPATO-Cy5 were assessed in mice over 24 h (percentage injected dose and percentage injected dose per gram of tissue, SPECT/CT imaging and fluorescence imaging). The ability to provide real-time fluorescence guidance during robot-assisted hepatobiliary surgery was evaluated in a porcine model using ICG as a reference. Results: The unique molecular signature of hHEPATO-Cy5 promotes hepatobiliary excretion. In vitro studies on hepatocytes showed that where methylated Cy5 remained internalized, hHEPATO-Cy5 showed fast clearance (10 min) similar to that of fluorescent bile salt. In vivo use of 99mTc-hHEPATO-Cy5 in mice revealed liver accumulation and rapid biliary clearance. The effectiveness of bile clearance was best exemplified by the 2-orders-of-magnitude reduction in count rate for the gallbladder (P = 0.008) over time. During hepatobiliary surgery in a porcine model, hHEPATO-Cy5 enabled fluorescence-based lesion identification comparable to that of ICG. Conclusion: The bimodal 99mTc-hHEPATO-Cy5 provides an effective means to identify liver lesions. Uniquely, it helps overcome the shortcomings of fluorescence-only approaches by allowing for an extension to in-depth radioguidance.
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Affiliation(s)
- Daphne D D Rietbergen
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - Leon J Slof
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten P van Meerbeek
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - Clarize M de Korne
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mick M Welling
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Meta Roestenberg
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands;
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Lee CH, Zaman S, Kundra V, Anvari B. Erythrocyte nano-ghosts with dual optical and magnetic resonance characteristics. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:085001. [PMID: 39165858 PMCID: PMC11333968 DOI: 10.1117/1.jbo.29.8.085001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/22/2024]
Abstract
Significance Fluorescent organic dyes provide imaging capabilities at cellular and sub-cellular levels. However, a common problem associated with some of the existing dyes such as the US FDA-approved indocyanine green (ICG) is their weak fluorescence emission. Alternative dyes with greater emission characteristics would be useful in various imaging applications. Complementing optical imaging, magnetic resonance (MR) imaging enables deep tissue imaging. Nano-sized delivery systems containing dyes with greater fluorescence emission as well as MR contrast agents present a promising dual-mode platform with high optical sensitivity and deep tissue imaging for image-guided surgical applications. Aim We have engineered a nano-sized platform, derived from erythrocyte ghosts (EGs), with dual near-infrared fluorescence and MR characteristics by co-encapsulation of a brominated carbocyanine dye and gadobenate dimeglumine (Gd-BOPTA). Approach We have investigated the use of three brominated carbocyanine dyes (referred to as BrCy106, BrCy111, and BrCy112) with various degrees of bromination, structural symmetry, and acidic modifications for encapsulation by nano-sized EGs (nEGs) and compared their resulting optical characteristics with nEGs containing ICG. Results We find that asymmetric dyes (BrCy106 and BrCy112) with one dibromobenzene ring offer greater fluorescence emission characteristics. For example, the relative fluorescence quantum yield ( ϕ ) for nEGs fabricated using 100 μ M of BrCy112 is ∼ 41 -fold higher than nEGs fabricated using the same concentrations of ICG. The dual-mode nEGs containing BrCy112 and Gd-BOPTA show a nearly twofold increase in their ϕ as compared with their single optical mode counterpart. Cytotoxicity is not observed upon incubation of SKOV3 cells with nEGs containing BrCy112. Conclusions Erythrocyte nano-ghosts with dual optical and MR characteristics may ultimately prove useful in various biomedical imaging applications such as image-guided tumor surgery where MR imaging can be used for tumor staging and mapping, and fluorescence imaging can help visualize small tumor nodules for resection.
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Affiliation(s)
- Chi-Hua Lee
- University of California, Riverside, Department of Biochemistry, Riverside, California, United States
| | - Shamima Zaman
- University of California, Riverside, Department of Bioengineering, Riverside, California, United States
| | - Vikas Kundra
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland, United States
- University of Maryland, Stuart and Marlene Greenbaum Comprehensive Cancer Center, Baltimore, Maryland, United States
| | - Bahman Anvari
- University of California, Riverside, Department of Biochemistry, Riverside, California, United States
- University of California, Riverside, Department of Bioengineering, Riverside, California, United States
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8
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Chow CY, King GF. Shining a Light on Venom-Peptide Receptors: Venom Peptides as Targeted Agents for In Vivo Molecular Imaging. Toxins (Basel) 2024; 16:307. [PMID: 39057947 PMCID: PMC11281729 DOI: 10.3390/toxins16070307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
Molecular imaging has revolutionised the field of biomedical research by providing a non-invasive means to visualise and understand biochemical processes within living organisms. Optical fluorescent imaging in particular allows researchers to gain valuable insights into the dynamic behaviour of a target of interest in real time. Ion channels play a fundamental role in cellular signalling, and they are implicated in diverse pathological conditions, making them an attractive target in the field of molecular imaging. Many venom peptides exhibit exquisite selectivity and potency towards ion channels, rendering them ideal agents for molecular imaging applications. In this review, we illustrate the use of fluorescently-labelled venom peptides for disease diagnostics and intraoperative imaging of brain tumours and peripheral nerves. Finally, we address challenges for the development and clinical translation of venom peptides as nerve-targeted imaging agents.
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Affiliation(s)
- Chun Yuen Chow
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, QLD 4072, Australia
- Australia Research Council Centre of Excellence for Innovations in Peptide and Protein Science, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Glenn F. King
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, QLD 4072, Australia
- Australia Research Council Centre of Excellence for Innovations in Peptide and Protein Science, The University of Queensland, St. Lucia, QLD 4072, Australia
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9
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She WH, Chan MY, Tsang SHY, Dai WC, Chan ACY, Lo CM, Cheung TT. Correlation of pathological examination with indocyanine green (ICG) intensity gradients: a prospective study in patients with liver tumor. Surg Endosc 2024; 38:3441-3447. [PMID: 38691133 PMCID: PMC11133210 DOI: 10.1007/s00464-024-10840-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Intraoperative indocyanine green (ICG) fluorescence imaging has been shown to be a new and innovative way to illustrate the optimal resection margin in hepatectomy for hepatocellular carcinoma. This study investigated its accuracy in resection margin determination by looking into the correlation of ICG intensity gradients with pathological examination results of resected specimens. METHODS This was a prospective, single-center, non-randomized controlled study. Patients who had liver tumors indicating liver resection were recruited. The hypothesis was that the use of intraoperative near-infrared/ICG fluorescence imaging would be a promising guiding tool for removing hepatocellular carcinoma with a better resection margin. Patients were given ICG (0.25 mg/kg) 1 day before operation. Resected specimens were inspected under a fluorescent imaging system. Biopsies were taken from tumors and normal tissue. Color signals obtained from ICG fluorescence imaging were compared with biopsies for analysis. RESULTS Twenty-two patients were recruited for study. The median size of their tumors was 2.25 cm. One patient had resection margin involvement. Under ICG fluorescence, the tumors typically lighted up as yellow color, wrapped by a zone of green color. Tumors of 17 patients (77.3%) displayed yellow color and were confirmed malignancy, while tumors of 12 patients (54.5%) displayed green color and were confirmed malignancy. Receiver operating characteristic curve was used to measure the sensitivity and specificity of the green color to look for a clear resection margin. The area under the curve was 85.3% (p = 0.019, 95% confidence interval 0.696-1.000), with a sensitivity of 0.706 and specificity of 1.000. CONCLUSION The use of ICG fluorescence can be helpful in determining resection margins. Resection of tumor should include complete resection of the green zone shown in the fluorescence image.
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Affiliation(s)
- Wong Hoi She
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Miu Yee Chan
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Simon Hing Yin Tsang
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Wing Chiu Dai
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Albert Chi Yan Chan
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Chung Mau Lo
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Tan To Cheung
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
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Kim SK, Seok J, Lee CY, Ryu CH, Choi SY, Park SY, Lee YK, Hwangbo Y, Lee EK, Lee YJ, Park S, Kim TS, Kim TH, Ryu J, Jung YS. The Efficacy and Safety of an Indocyanine Green-Macroaggregated Albumin-Hyaluronic Acid Mixture (LuminoMark™) for Surgical Localization of Recurrent Thyroid Cancer. Ann Surg Oncol 2024; 31:2349-2356. [PMID: 38308160 DOI: 10.1245/s10434-023-14831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/10/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND The recurrence of thyroid cancer poses challenges compounded by postoperative fibrosis and anatomic changes. By overcoming the limitations of current localizing dye techniques, indocyanine green-macroaggregated albumin-hyaluronic acid (ICG-MAA-HA) mixture dye promises improved localization. This study aimed to evaluate the efficacy and safety of the dye for recurrent thyroid cancer. METHODS The nine patients in this study underwent surgery and postoperative ultrasonography. The dye was injected into recurrent lesions in all the patients preoperatively. During surgery, the lesions were confirmed with an imaging system before and after excision. If the lesion was unidentifiable with the naked eye, surgical excision was performed under the corresponding fluorescent guide. Side effects related to the dye injection and completeness of the surgery were evaluated. RESULTS No side effects such as bleeding, skin tattooing, or pain during or after the dye injection were reported, and no discoloration occurred that interfered with the surgical field of view during surgery. In three cases (33.3 %), because it was difficult to localize metastatic lesions with the naked eye, the operation was successfully completed using an imaging system. The completeness of the surgical resection was confirmed by ultrasonography after an average of 5 months postoperatively. CONCLUSION The study found that ICG-MAA-HA dye effectively located metastatic and recurrent thyroid cancer and had favorable results in terms of minimal procedural side effects and potential for assisting the surgeon. A large-scale multi-institutional study is necessary to prove the clinical significance regarding patient survival and disease control.
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Affiliation(s)
- Seok-Ki Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang Yoon Lee
- Department of Radiology, National Cancer Center, Goyang, Republic of Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Republic of Korea
| | - Sung Yong Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Republic of Korea
| | - Seog Yun Park
- Department of Pathology, National Cancer Center, Goyang, Republic of Korea
| | - Young Ki Lee
- Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Yul Hwangbo
- Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
| | - You Jin Lee
- Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Sohyun Park
- Department of Nuclear Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Tae Sung Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Tae Hyun Kim
- Department of Radiation Oncology, National Cancer Center, Goyang, Republic of Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Republic of Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Republic of Korea.
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11
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van Dam MA, Crobach ASLP, Boekestijn B, Corssmit EPM, Bonsing BA, Vahrmeijer AL, Mieog JSD. Fluorescence-guided minimally-invasive resection of abdominal paragangliomas using indocyanine green. Sci Rep 2024; 14:3983. [PMID: 38368490 PMCID: PMC10874414 DOI: 10.1038/s41598-024-54718-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/15/2024] [Indexed: 02/19/2024] Open
Abstract
This retrospective study explores the utility of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) in enhancing the intraoperative identification and guidance for the resection of abdominal paragangliomas. They can be challenging to detect during minimally invasive surgery, due to their anatomical location, varying size and similar appearance in regard to their surrounding tissue. Patients with suspected abdominal paragangliomas planned for a minimally-invasive resection were included. As part of standard of care they received single intravenous dose of 5 mg ICG after abdominal exploration. NIR fluorescence imaging of the anatomical region of the suspected lesion was performed immediately following intravenous administration, to assess fluorescence signals, intraoperative identification, and histopathological correlation. Out of five resected suspicious lesions, four were imaged with NIR fluorescence, pathology confirming four as paragangliomas, the latter turned out to be an adrenal adenoma. NIR fluorescence identified all four lesions, surpassing the limitations of white-light visualization. Homogeneous fluorescence signals appeared 30-60 s post-ICG administration, which lasted up to 30 min. The study demonstrates the feasibility and potential clinical value of fluorescence-guided minimally-invasive resections of abdominal paragangliomas using a single intravenous ICG dose. These findings support the scientific basis for routine use of ICG-fluorescence-guided surgery in challenging anatomical cases, providing valuable assistance in lesion detection and resection.
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Affiliation(s)
- M A van Dam
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - A S L P Crobach
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - E P M Corssmit
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - B A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J S D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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12
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Dijkhuis TH, Bijlstra OD, Warmerdam MI, Faber RA, Linders DGJ, Galema HA, Broersen A, Dijkstra J, Kuppen PJK, Vahrmeijer AL, Mieog JSD. Semi-automatic standardized analysis method to objectively evaluate near-infrared fluorescent dyes in image-guided surgery. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:026001. [PMID: 38312853 PMCID: PMC10833575 DOI: 10.1117/1.jbo.29.2.026001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 02/06/2024]
Abstract
Significance Near-infrared fluorescence imaging still lacks a standardized, objective method to evaluate fluorescent dye efficacy in oncological surgical applications. This results in difficulties in translation between preclinical to clinical studies with fluorescent dyes and in the reproduction of results between studies, which in turn hampers further clinical translation of novel fluorescent dyes. Aim Our aim is to develop and evaluate a semi-automatic standardized method to objectively assess fluorescent signals in resected tissue. Approach A standardized imaging procedure was designed and quantitative analysis methods were developed to evaluate non-targeted and tumor-targeted fluorescent dyes. The developed analysis methods included manual selection of region of interest (ROI) on white light images, automated fluorescence signal ROI selection, and automatic quantitative image analysis. The proposed analysis method was then compared with a conventional analysis method, where fluorescence signal ROIs were manually selected on fluorescence images. Dice similarity coefficients and intraclass correlation coefficients were calculated to determine the inter- and intraobserver variabilities of the ROI selections and the determined signal- and tumor-to-background ratios. Results The proposed non-targeted fluorescent dyes analysis method showed statistically significantly improved variabilities after application on indocyanine green specimens. For specimens with the targeted dye SGM-101, the variability of the background ROI selection was statistically significantly improved by implementing the proposed method. Conclusion Semi-automatic methods for standardized quantitative analysis of fluorescence images were successfully developed and showed promising results to further improve the reproducibility and standardization of clinical studies evaluating fluorescent dyes.
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Affiliation(s)
- Tom H. Dijkhuis
- Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
| | - Okker D. Bijlstra
- Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
- Amsterdam University Medical Center, Cancer Center Amsterdam, Department of Surgery, Amsterdam, The Netherlands
| | - Mats I. Warmerdam
- Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
- Centre of Human Drug Research, Leiden, The Netherlands
| | - Robin A. Faber
- Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
| | - Daan G. J. Linders
- Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
| | - Hidde A. Galema
- Erasmus MC Cancer Institute, Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, The Netherlands
| | - Alexander Broersen
- Leiden University Medical Center, Department of Radiology, Leiden, The Netherlands
| | - Jouke Dijkstra
- Leiden University Medical Center, Department of Radiology, Leiden, The Netherlands
| | - Peter J. K. Kuppen
- Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
| | | | - Jan Sven David Mieog
- Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
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13
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Brollo PP, Bresadola V. Enhancing visualization and guidance in general surgery: a comprehensive and narrative review of the current cutting-edge technologies and future perspectives. J Gastrointest Surg 2024; 28:179-185. [PMID: 38445941 DOI: 10.1016/j.gassur.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/25/2023] [Accepted: 12/08/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND In the last decade, there has been a great effort in developing new technologies to enhance surgical visualization and guidance. This comprehensive and narrative review aimed to provide a wide and extensive overview of the current state of the art on this topic and their near-future perspectives linked to the development of artificial intelligence (AI), by focusing on the most recent and relevant literature. METHODS A comprehensive and narrative review of the literature was performed by searching specific terms on PubMed/MEDLINE, Scopus, and Embase databases, assessing the current state of the art on this topic. RESULTS Fluorescence-guided surgery, contrast-enhanced ultrasound (CEUS), ultra-high frequency ultrasound (UHFUS), photoacoustic imaging (PAI), and augmented reality (AR) are boosting the field of image-guided techniques as the rapid development of AI in surgery is promising a more automated decision-making and surgical movements in the operating room. CONCLUSION Fluorescence-guided surgery, CEUS, UHFUS, PAI, and AR are becoming crucial to give surgeons a new level of information during the intervention, with the right timing and sequence, and represent the future of surgery. As many more controlled studies are needed to validate the employment of these technologies, the next generation of surgeons must become more familiar with the basics of AI to better incorporate new tools into the daily surgical practice of the future.
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Affiliation(s)
- Pier Paolo Brollo
- Department of Medicine, General Surgery Department and Simulation Center, Academic Hospital of Udine, University of Udine, Udine, Italy; General Surgical Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico di Aviano (Istituto Nazionale Tumori), Aviano, Italy.
| | - Vittorio Bresadola
- Department of Medicine, General Surgery Department and Simulation Center, Academic Hospital of Udine, University of Udine, Udine, Italy
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14
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Owusu-Brackett N, Chakedis JM, Dedhia P, Gilliam C, Agrawal A, Kang SY, Old M, Miller BS, Phay JE. Efficacy and safety of near-infrared fluorescence identification of the thoracic duct during left lateral neck dissection. Surgery 2024; 175:134-138. [PMID: 38057229 DOI: 10.1016/j.surg.2023.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/20/2023] [Accepted: 08/17/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Thoracic duct leaks occur in up to 5% of left lateral neck dissections. No one imaging modality is routinely used to identify the thoracic duct intraoperatively. The goal of our study was to evaluate the efficacy and safety of indocyanine green lymphangiography for intraoperative identification of the thoracic duct compared to traditional methods using ambient and evaluate the optimal timing of indocyanine green administration. METHODS We enrolled all patients who underwent left lateral neck dissection at our institution from 2018 to 2022 in this prospective clinical trial. After indocyanine green injection into the dorsum of the foot, we performed intraoperative imaging was performed with a near-infrared fluorescence camera. We reported the data using descriptive statistics. RESULTS Of the 42 patients we enrolled, 14 had prior neck surgery, and 3 had prior external beam radiation. We visualized the thoracic duct with ambient light in 48% of patients and with near-infrared fluorescence visualization in 64%. In 17% of patients, we could identify the thoracic duct only using near-infrared fluorescence visualization, which occurred within 3 minutes of injection, and were required to re-dose 5 patients. We visualized the thoracic duct with near-infrared fluorescence in all patients with prior neck radiation and 77% of patients with prior neck surgery. One adverse reaction occurred (hypotension), and 5 intraoperative thoracic duct injuries occurred that were ligated. There with no chylous fistulas postoperatively. CONCLUSION This trial demonstrates that near-infrared fluorescence identification of the thoracic duct is feasible and safe with indocyanine green lymphangiography, even in patients with prior neck surgery or radiation.
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Affiliation(s)
- Nicci Owusu-Brackett
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | - Jeffery M Chakedis
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH; Department of General Surgery, The Permanente Medical Group, Walnut Creek, CA
| | - Priya Dedhia
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | - Christopher Gilliam
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, OH
| | - Stephan Y Kang
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, OH
| | - Matthew Old
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, OH
| | - Barbra S Miller
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | - John E Phay
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH.
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15
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Izquierdo-García E, Rovira A, Forcadell J, Bosch M, Marchán V. Exploring Structural-Photophysical Property Relationships in Mitochondria-Targeted Deep-Red/NIR-Emitting Coumarins. Int J Mol Sci 2023; 24:17427. [PMID: 38139255 PMCID: PMC10743691 DOI: 10.3390/ijms242417427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Organic fluorophores operating in the optical window of biological tissues, namely in the deep-red and near-infrared (NIR) region of the electromagnetic spectrum, offer several advantages for fluorescence bioimaging applications owing to the appealing features of long-wavelength light, such as deep tissue penetration, lack of toxicity, low scattering, and reduced interference with cellular autofluorescence. Among these, COUPY dyes based on non-conventional coumarin scaffolds display suitable photophysical properties and efficient cellular uptake, with a tendency to accumulate primarily in mitochondria, which renders them suitable probes for bioimaging purposes. In this study, we have explored how the photophysical properties and subcellular localization of COUPY fluorophores can be modulated through the modification of the coumarin backbone. While the introduction of a strong electron-withdrawing group, such as the trifluoromethyl group, at position 4 resulted in an exceptional photostability and a remarkable redshift in the absorption and emission maxima when combined with a julolidine ring replacing the N,N-dialkylaminobenzene moiety, the incorporation of a cyano group at position 3 dramatically reduced the brightness of the resulting fluorophore. Interestingly, confocal microscopy studies in living HeLa cells revealed that the 1,1,7,7-tetramethyl julolidine-containing derivatives accumulated in the mitochondria with much higher specificity. Overall, our results provide valuable insights for the design and optimization of new COUPY dyes operating in the deep-red/NIR region.
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Affiliation(s)
- Eduardo Izquierdo-García
- Secció de Química Orgànica, Departament de Química Inorgànica i Orgànica, Institut de Biomedicina de la Universitat de Barcelona (IBUB), Universitat de Barcelona (UB), Carrer Martí i Franquès 1-11, E-08028 Barcelona, Spain
| | - Anna Rovira
- Secció de Química Orgànica, Departament de Química Inorgànica i Orgànica, Institut de Biomedicina de la Universitat de Barcelona (IBUB), Universitat de Barcelona (UB), Carrer Martí i Franquès 1-11, E-08028 Barcelona, Spain
| | - Joan Forcadell
- Secció de Química Orgànica, Departament de Química Inorgànica i Orgànica, Institut de Biomedicina de la Universitat de Barcelona (IBUB), Universitat de Barcelona (UB), Carrer Martí i Franquès 1-11, E-08028 Barcelona, Spain
| | - Manel Bosch
- Unitat de Microscòpia Òptica Avançada, Centres Científics i Tecnològics de la Universitat de Barcelona (CCiTUB), Universitat de Barcelona (UB), Avinguda Diagonal 643, E-08028 Barcelona, Spain
| | - Vicente Marchán
- Secció de Química Orgànica, Departament de Química Inorgànica i Orgànica, Institut de Biomedicina de la Universitat de Barcelona (IBUB), Universitat de Barcelona (UB), Carrer Martí i Franquès 1-11, E-08028 Barcelona, Spain
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16
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Ma S, Sun B, Li M, Han T, Yu C, Wang X, Zheng X, Li S, Zhu S, Wang Q. High-precision detection and navigation surgery of colorectal cancer micrometastases. J Nanobiotechnology 2023; 21:403. [PMID: 37919717 PMCID: PMC10621104 DOI: 10.1186/s12951-023-02171-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
Surgical resection is an effective treatment for colorectal cancer (CRC) patients, whereas occult metastases hinder the curative effect. Currently, there is no effective method to achieve intraoperatively diagnosis of tumor-positive lymph nodes (LNs). Herein, we adopt a near-infrared-II (NIR-II) organic donor-pi-acceptor-pi-donor probe FE-2PEG, which exhibits bright fluorescence over 1100 nm, excellent photostability, blood circulation time, and biocompatibility, to achieve high-performance bioimaging with improved temporal and spatial resolution. Importantly, the FE-2PEG shows efficient passive enrichment in orthotopic CRC, metastatic mesenteric LNs, and peritoneal metastases by enhanced permeability and retention effect. Under NIR-II fluorescence-guided surgery (FGS), the peritoneal micrometastases were resected with a sensitivity of 94.51%, specificity of 86.59%, positive predictive value (PPV) of 96.57%, and negative predictive value of 79.78%. The PPV still achieves 96.07% even for micrometastases less than 3 mm. Pathological staining and NIR-II microscopy imaging proved that FE-2PEG could successfully delineate the boundary between the tumor and normal tissues. Dual-color NIR-II imaging strategy with FE-2PEG (1100 ~ 1300 nm) and PbS@CdS quantum dots (> 1500 nm) successfully protects both blood supply and normal tissues during surgery. The NIR-II-based FGS provides a promising prospect for precise intraoperative diagnosis and minimally invasive surgery of CRC.
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Affiliation(s)
- Shengjie Ma
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130012, People's Republic of China
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - Bin Sun
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Mengfei Li
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Tianyang Han
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Chenlong Yu
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Xin Wang
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Xue Zheng
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Shuang Li
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130012, People's Republic of China
| | - Shoujun Zhu
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China.
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China.
| | - Quan Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130012, People's Republic of China.
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17
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Mirbeik A, Ebadi N. Deep learning for tumor margin identification in electromagnetic imaging. Sci Rep 2023; 13:15925. [PMID: 37741854 PMCID: PMC10517989 DOI: 10.1038/s41598-023-42625-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023] Open
Abstract
In this work, a novel method for tumor margin identification in electromagnetic imaging is proposed to optimize the tumor removal surgery. This capability will enable the visualization of the border of the cancerous tissue for the surgeon prior or during the excision surgery. To this end, the border between the normal and tumor parts needs to be identified. Therefore, the images need to be segmented into tumor and normal areas. We propose a deep learning technique which divides the electromagnetic images into two regions: tumor and normal, with high accuracy. We formulate deep learning from a perspective relevant to electromagnetic image reconstruction. A recurrent auto-encoder network architecture (termed here DeepTMI) is presented. The effectiveness of the algorithm is demonstrated by segmenting the reconstructed images of an experimental tissue-mimicking phantom. The structure similarity measure (SSIM) and mean-square-error (MSE) average of normalized reconstructed results by the DeepTMI method are about 0.94 and 0.04 respectively, while that average obtained from the conventional backpropagation (BP) method can hardly overcome 0.35 and 0.41 respectively.
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Affiliation(s)
- Amir Mirbeik
- RadioSight LLC, Hoboken, NJ, 07030, USA
- Department of Electrical and Computer Engineering, Stevens Institute of Technology, 1 Castle Point Ter, Hoboken, NJ, 07030, USA
| | - Negar Ebadi
- Department of Electrical and Computer Engineering, Stevens Institute of Technology, 1 Castle Point Ter, Hoboken, NJ, 07030, USA.
- Stanford University School of Medicine, Stanford, CA, USA.
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18
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Patel I, Rehman S, McKay S, Bartlett D, Mirza D. Use of Near-Infrared Fluorescence Techniques in Minimally Invasive Surgery for Colorectal Liver Metastases. J Clin Med 2023; 12:5536. [PMID: 37685603 PMCID: PMC10488819 DOI: 10.3390/jcm12175536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 09/10/2023] Open
Abstract
Colorectal liver metastases (CRLM) afflict a significant proportion of patients with colorectal cancer (CRC), ranging from 25% to 30% of patients throughout the course of the disease. In recent years, there has been a surge of interest in the application of near-infrared fluorescence (NIRF) imaging as an intraoperative imaging technique for liver surgery. The utilisation of NIRF-guided liver surgery, facilitated by the administration of fluorescent dye indocyanine green (ICG), has gained traction in numerous medical institutions worldwide. This innovative approach aims to enhance lesion differentiation and provide valuable guidance for surgical margins. The use of ICG, particularly in minimally invasive surgery, has the potential to improve lesion detection rates, increase the likelihood of achieving R0 resection, and enable anatomically guided resections. However, it is important to acknowledge the limitations of ICG, such as its low specificity. Consequently, there has been a growing demand for the development of tumour-specific fluorescent probes and the advancement of camera systems, which are expected to address these concerns and further refine the accuracy and reliability of intraoperative fluorescence imaging in liver surgery. While NIRF imaging has been extensively studied in patients with CRLM, it is worth noting that a significant proportion of published research has predominantly focused on the detection of hepatocellular carcinoma (HCC). In this study, we present a comprehensive literature review of the existing literature pertaining to intraoperative fluorescence imaging in minimally invasive surgery for CRLM. Moreover, our analysis places specific emphasis on the techniques employed in liver resection using ICG, with a focus on tumour detection in minimal invasive surgery (MIS). Additionally, we delve into recent developments in this field and offer insights into future perspectives for further advancements.
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Affiliation(s)
- Ishaan Patel
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Saad Rehman
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Siobhan McKay
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
- Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW 2065, Australia
| | - David Bartlett
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Darius Mirza
- Hon Professor of HPB and Transplant Surgery, University of Birmingham, Edgbaston, Birmingham B15 2TH, UK
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19
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Bateman LM, Hebert KA, Nunziata JA, Streeter SS, Barth CW, Wang LG, Gibbs SL, Henderson ER. Preclinical evaluation of molecularly targeted fluorescent probes in perfused amputated human limbs. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:082802. [PMID: 36619496 PMCID: PMC9813435 DOI: 10.1117/1.jbo.28.8.082802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/09/2022] [Indexed: 06/17/2023]
Abstract
SIGNIFICANCE This first-in-kind, perfused, and amputated human limb model allows for the collection of human data in preclinical selection of lead fluorescent agents. The model facilitates more accurate selection and testing of fluorophores with human-specific physiology, such as differential uptake and signal in fat between animal and human models with zero risk to human patients. Preclinical testing using this approach may also allow for the determination of tissue toxicity, clearance time of fluorophores, and the production of harmful metabolites. AIM This study was conducted to determine the fluorescence intensity values and tissue specificity of a preclinical, nerve tissue targeted fluorophore, as well as the capacity of this first-in-kind model to be used for lead fluorescent agent selection in the future. APPROACH Freshly amputated human limbs were perfused for 30 min prior to in situ and ex vivo imaging of nerves with both open-field and closed-field commercial fluorescence imaging systems. RESULTS In situ, open-field imaging demonstrated a signal-to-background ratio (SBR) of 4.7 when comparing the nerve with adjacent muscle tissue. Closed-field imaging demonstrated an SBR of 3.8 when the nerve was compared with adipose tissue and 4.8 when the nerve was compared with muscle. CONCLUSIONS This model demonstrates an opportunity for preclinical testing, evaluation, and selection of fluorophores for use in clinical trials as well as an opportunity to study peripheral pathologies in a controlled environment.
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Affiliation(s)
- Logan M. Bateman
- Dartmouth Health, Department of Orthopaedics, Lebanon, New Hampshire, United States
| | - Kendra A. Hebert
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Jenna A. Nunziata
- Dartmouth Health, Heart and Vascular Center, Lebanon, New Hampshire, United States
| | - Samuel S. Streeter
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Connor W. Barth
- Oregon Health and Science University, Department of Biomedical Engineering, Portland, Oregon, United States
| | - Lei G. Wang
- Oregon Health and Science University, Department of Biomedical Engineering, Portland, Oregon, United States
| | - Summer L. Gibbs
- Oregon Health and Science University, Department of Biomedical Engineering, Portland, Oregon, United States
| | - Eric R. Henderson
- Dartmouth Health, Department of Orthopaedics, Lebanon, New Hampshire, United States
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Dartmouth College, Geisel School of Medicine, Hanover, New Hampshire, United States
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20
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Rompianesi G, Pegoraro F, Ramaci L, Ceresa CD, Montalti R, Troisi RI. Preoperative planning and intraoperative real-time navigation with indocyanine green fluorescence in robotic liver surgery. Langenbecks Arch Surg 2023; 408:292. [PMID: 37522938 PMCID: PMC10390613 DOI: 10.1007/s00423-023-03024-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE We aimed at exploring indocyanine green (ICG) fluorescence wide spectrum of applications in hepatobiliary surgery as can result particularly useful in robotic liver resections (RLR) in order to overcome some technical limitations, increasing safety, and efficacy. METHODS We describe our experience of 76 RLR performed between March 2020 and December 2022 exploring all the possible applications of pre- and intraoperative ICG administration. RESULTS Hepatocellular carcinoma and colorectal liver metastases were the most common indications for RLR (34.2% and 26.7% of patients, respectively), and 51.3% of cases were complex resections with high IWATE difficulty scores. ICG was administered preoperatively in 61 patients (80.3%), intraoperatively in 42 patients (55.3%) and in both contexts in 25 patients (32.9%), with no observed adverse events. The most frequent ICG goal was to achieve tumor enhancement (59 patients, 77.6%), with a success rate of 94.9% and the detection of 3 additional malignant lesions. ICG facilitated evaluation of the resection margin for residual tumor and perfusion adequacy in 33.9% and 32.9% of cases, respectively, mandating a resection enlargement in 7.9% of patients. ICG fluorescence allowed the identification of the transection plane through negative staining in the 25% of cases. Vascular and biliary structures were visualized in 21.1% and 9.2% of patients, with a success rate of 81.3% and 85.7%, respectively. CONCLUSION RLR can benefit from the routine integration of ICG fluoresce evaluation according to each individual patient and condition-specific goals and issues, allowing liver functional assessment, anatomical and vascular evaluation, tumor detection, and resection margins assessment.
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Affiliation(s)
- Gianluca Rompianesi
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini n. 5, Naples, Italy.
| | - Francesca Pegoraro
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini n. 5, Naples, Italy
| | - Lorenzo Ramaci
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini n. 5, Naples, Italy
| | - Carlo Dl Ceresa
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Roberto Montalti
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Public Health Federico II University Hospital, Naples, Italy
| | - Roberto I Troisi
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini n. 5, Naples, Italy
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Husarova T, MacCuaig WM, Dennahy IS, Sanderson EJ, Edil BH, Jain A, Bonds MM, McNally MW, Menclova K, Pudil J, Zaruba P, Pohnan R, Henson CE, Grizzle WE, McNally LR. Intraoperative Imaging in Hepatopancreatobiliary Surgery. Cancers (Basel) 2023; 15:3694. [PMID: 37509355 PMCID: PMC10377919 DOI: 10.3390/cancers15143694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Hepatopancreatobiliary surgery belongs to one of the most complex fields of general surgery. An intricate and vital anatomy is accompanied by difficult distinctions of tumors from fibrosis and inflammation; the identification of precise tumor margins; or small, even disappearing, lesions on currently available imaging. The routine implementation of ultrasound use shifted the possibilities in the operating room, yet more precision is necessary to achieve negative resection margins. Modalities utilizing fluorescent-compatible dyes have proven their role in hepatopancreatobiliary surgery, although this is not yet a routine practice, as there are many limitations. Modalities, such as photoacoustic imaging or 3D holograms, are emerging but are mostly limited to preclinical settings. There is a need to identify and develop an ideal contrast agent capable of differentiating between malignant and benign tissue and to report on the prognostic benefits of implemented intraoperative imaging in order to navigate clinical translation. This review focuses on existing and developing imaging modalities for intraoperative use, tailored to the needs of hepatopancreatobiliary cancers. We will also cover the application of these imaging techniques to theranostics to achieve combined diagnostic and therapeutic potential.
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Affiliation(s)
- Tereza Husarova
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
- Department of Surgery, Military University Hospital Prague, 16902 Prague, Czech Republic
| | - William M. MacCuaig
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Isabel S. Dennahy
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Emma J. Sanderson
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Barish H. Edil
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Ajay Jain
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Morgan M. Bonds
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Molly W. McNally
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Katerina Menclova
- Department of Surgery, Military University Hospital Prague, 16902 Prague, Czech Republic
| | - Jiri Pudil
- Department of Surgery, Military University Hospital Prague, 16902 Prague, Czech Republic
| | - Pavel Zaruba
- Department of Surgery, Military University Hospital Prague, 16902 Prague, Czech Republic
| | - Radek Pohnan
- Department of Surgery, Military University Hospital Prague, 16902 Prague, Czech Republic
| | - Christina E. Henson
- Department of Radiation Oncology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - William E. Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Lacey R. McNally
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
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22
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von Kroge PH, Duprée A. Fluorescent Imaging in Visceral Surgery: Current Opportunities and Future Perspectives. Visc Med 2023; 39:39-45. [PMID: 37405326 PMCID: PMC10315688 DOI: 10.1159/000530362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/21/2023] [Indexed: 07/06/2023] Open
Abstract
Background Fluorescent imaging using indocyanine green (FI-ICG) has become quite popular in the past century, giving the surgeon various pre- and intraoperative approaches in visceral surgery. Nevertheless, several aspects and pitfalls of using the technology need to be addressed. Summary This article focused on the applications of FI-ICG in esophageal and colorectal surgery as this is where the clinical relevance is most important. Important benchmark studies were summarized to explain the background. In addition, dosage, the timing of application, and future perspectives - especially quantification methods - were the article's content. Key Message There are currently encouraging data on the use of FI-ICG, particularly concerning perfusion assessment to reduce anastomotic leakage, although its use is mainly subjective. The optimal dosage remains unclear; for perfusion evaluation, it should be around 0.1 mg/kg body weight. Moreover, the quantification of FI-ICG opens new possibilities, so that reference values may be available in the future. However, in addition to perfusion measurement, the detection of additional hepatic lesions such as liver metastases or lesions of peritoneal carcinomatosis is also possible. A standardization of FI-ICG and further studies are needed to fully utilize FI-ICG.
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Affiliation(s)
- Philipp H von Kroge
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Duprée
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Patel I, Bartlett D, Dasari BV, Chatzizacharias N, Isaac J, Marudanayagam R, Mirza DF, Roberts JK, Sutcliffe RP. Detection of Colorectal Liver Metastases Using Near-Infrared Fluorescence Imaging During Hepatectomy: Prospective Single Centre UK Study. J Gastrointest Cancer 2023; 54:574-579. [PMID: 35616823 DOI: 10.1007/s12029-022-00836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Small superficial colorectal liver metastases (CLM) may be difficult to localise intraoperatively, especially during minimally invasive hepatectomy due to reduced tactile feedback and limitations of ultrasound (US). Near-infrared (NIRF) fluorescence imaging is an emerging technology that permits detection of liver tumours after systemic injection of indocyanine green (ICG). Our aim was to report our experience using NIRF to detect CLM. PATIENTS AND METHODS Patients with small, superficial resectable CLM received a 10-mg IV bolus of ICG the day before hepatectomy. All patients underwent preoperative liver-specific MRI. CLM were localised intraoperatively using a combination of white light/ultrasound (WL-US) and NIRF. Sensitivity and specificity of NIRF were compared with WL-US. RESULTS Between March 2019 and July 2021, NIRF was utilised in 15 patients who underwent hepatectomy (laparoscopic 13, open 2). Thirty-two lesions were detected by MRI (including 3 disappearing CLM), of which 2 were ICG-negative and not resected (1 haemangioma, 1 disappearing CLM). Of 30 resected lesions, the median tumour diameter was 11 mm (range 2-25), median distance from liver surface was 4.5 mm (range 0-20) and all were confirmed CLM on histology (R0 resection rate 71%). Twenty-three of thirty (77%) and twenty-seven of thirty (90%) resected CLM were detected by WL-US and NIRF, respectively. Of 7/30 (23%) resected CLM that were WL-US negative, 5 were ICG-positive. Two resected 'disappearing' CLM were ICG-positive, one of which contained viable cancer cells. Overall, NIRF influenced the operative strategy in 6 patients (43%). CONCLUSION Near-infrared fluorescence imaging allows detection of small, superficial colorectal liver metastases that are missed by conventional techniques and warrants further study.
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Affiliation(s)
- Ishaan Patel
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham, B15 2TH, UK.
| | - David Bartlett
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Bobby V Dasari
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Nikolaos Chatzizacharias
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - John Isaac
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Ravi Marudanayagam
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Darius F Mirza
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - J Keith Roberts
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Robert P Sutcliffe
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham, B15 2TH, UK
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Weixler B, Lobbes LA, Scheiner L, Lauscher JC, Staubli SM, Zuber M, Raptis DA. The Value of Indocyanine Green Image-Guided Surgery in Patients with Primary Liver Tumors and Liver Metastases. Life (Basel) 2023; 13:1290. [PMID: 37374073 DOI: 10.3390/life13061290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/13/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Successful R0 resection is crucial for the survival of patients with primary liver cancer (PLC) or liver metastases. Up to date, surgical resection lacks a sensitive, real-time intraoperative imaging modality to determine R0 resection. Real-time intraoperative visualization with near-infrared light fluorescence (NIRF) using indocyanine green (ICG) may have the potential to meet this demand. This study evaluates the value of ICG visualization in PLC and liver metastases surgery regarding R0 resection rates. MATERIALS AND METHODS Patients with PLC or liver metastases were included in this prospective cohort study. ICG 10 mg was administered intravenously 24 h before surgery. Real-time intraoperative NIRF visualization was created with the SpectrumTM fluorescence imaging camera system. First, all liver segments were inspected with the fluorescence imaging system and intraoperative ultrasound for identification of the known tumor, as well as additional lesions, and were compared to preoperative MRI images. PLC, liver metastases, and additional lesions were then resected according to oncological principles. In all resected specimens, the resection margins were analyzed with the fluorescence imaging system for ICG-positive spots immediately after resection. Histology of additional detected lesions, as well as ICG fluorescence compared to histological resection margins, were assessed. RESULTS Of the 66 included patients, median age was 65.5 years (IQR 58.7-73.9), 27 (40.9%) were female, and 18 (27.3%) were operated on laparoscopically. Additional ICG-positive lesions were detected in 23 (35.4%) patients, of which 9 (29%) were malignant. In patients with no fluorescent signal at the resection margin, R0 rate was 93.9%, R1 rate was 6.1%, and R2 rate was 0% compared to an ICG-positive resection margin with an R0 rate of 64.3%, R1 rate of 21.4%, and R2 rate of 14.3% (p = 0.005). One- and two-year overall survival rates were 95.2% and 88.4%, respectively. CONCLUSION The presented study provides significant evidence that ICG NIRF guidance helps to identify R0 resection intraoperatively. This offers true potential to verify radical resection and improve patient outcomes. Furthermore, implementation of NIRF-guided imaging in liver tumor surgery allows us to detect a considerable amount of additional malignant lesions.
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Affiliation(s)
- Benjamin Weixler
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Leonard A Lobbes
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Luis Scheiner
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Johannes C Lauscher
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Sebastian M Staubli
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Royal Free Hospital, London NW3 2QG, UK
| | - Markus Zuber
- Clarunis University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4058 Basel, Switzerland
| | - Dimitri A Raptis
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Royal Free Hospital, London NW3 2QG, UK
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Sutton PA, van Dam MA, Cahill RA, Mieog S, Polom K, Vahrmeijer AL, van der Vorst J. Fluorescence-guided surgery: comprehensive review. BJS Open 2023; 7:7162090. [PMID: 37183598 PMCID: PMC10183714 DOI: 10.1093/bjsopen/zrad049] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Despite significant improvements in preoperative workup and surgical planning, surgeons often rely on their eyes and hands during surgery. Although this can be sufficient in some patients, intraoperative guidance is highly desirable. Near-infrared fluorescence has been advocated as a potential technique to guide surgeons during surgery. METHODS A literature search was conducted to identify relevant articles for fluorescence-guided surgery. The literature search was performed using Medical Subject Headings on PubMed for articles in English until November 2022 and a narrative review undertaken. RESULTS The use of invisible light, enabling real-time imaging, superior penetration depth, and the possibility to use targeted imaging agents, makes this optical imaging technique increasingly popular. Four main indications are described in this review: tissue perfusion, lymph node assessment, anatomy of vital structures, and tumour tissue imaging. Furthermore, this review provides an overview of future opportunities in the field of fluorescence-guided surgery. CONCLUSION Fluorescence-guided surgery has proven to be a widely innovative technique applicable in many fields of surgery. The potential indications for its use are diverse and can be combined. The big challenge for the future will be in bringing experimental fluorophores and conjugates through trials and into clinical practice, as well as validation of computer visualization with large data sets. This will require collaborative surgical groups focusing on utility, efficacy, and outcomes for these techniques.
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Affiliation(s)
- Paul A Sutton
- The Colorectal and Peritoneal Oncology Centre, Christie Hospital, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Martijn A van Dam
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronan A Cahill
- RAC, UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
- RAC, Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sven Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Karol Polom
- Clinic of Oncological, Transplantation and General Surgery, Gdansk Medical University, Gdansk, Poland
| | | | - Joost van der Vorst
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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26
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Song J, Ren T, Duan Y, Guo H, Wang G, Gan Y, Bai M, Dong X, Zhao Z, An J. Near-infrared fluorescence imaging of hepatocellular carcinoma cells regulated by β-catenin signaling pathway. Front Oncol 2023; 13:1140256. [PMID: 37064109 PMCID: PMC10090467 DOI: 10.3389/fonc.2023.1140256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundNear-infrared fluorescence (NIRF) imaging has recently emerged as a promising tool for noninvasive cancer imaging. However, lack of tumor sensitivity and specificity restricts the application of NIRF dyes in surgical navigation.MethodsHerein, we investigated the imaging features of NIRF dye MHI-148 and indocyanine green (ICG) in live cell imaging and xenograft nude mice models. TCGA dataset analysis and immunohistochemistry were conducted to investigate the expression of OATPs or ABCGs in hepatocellular carcinoma (HCC) tissues. OATPs or ABCGs were knocked down and overexpressed in HCC cells using transient transfection by siRNA and plasmids or stable transfection by lentivirus. Further, qRT-PCR ,Western blotting and the use of agonists or inhibitors targeting β-catenin signaling pathway were applied to explore its important role in regulation of OATP2B1 and ABCG2 expression.ResultsHere we demonstrated that NIRF dye MHI-148 was biocompatible as indocyanine green (ICG) but with higher imaging intensity and preferential uptake and retention in hepatocellular carcinoma (HCC) cells and tissues. Moreover, our data indicated that membrane transporters OATP2B1 and ABCG2, which regulated by β-catenin signaling pathway, mediated tumor-specific accumulation and retention of MHI-148 in HCC cells. In addition, the treatment with β-catenin inhibitor significantly enhanced the accumulation of MHI-148 in HCC tissues and improved the efficacy of tumor imaging with MHI-148 in vivo.ConclusionsOur study uncovers a mechanism that links the distribution and expression of the membrane transporters OATP2B1 and ABCG2 to the tumor-specific accumulation of MHI-148, and provides evidence supporting a regulating role of the β-catenin signaling pathway in OATP2B1 and ABCG2- induced retention of MHI-148 inHCC tissues, and strategy targeting key components of MHI-148 transport machinery may be a potential approach to improve HCC imaging.
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Affiliation(s)
- Jian Song
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Tingting Ren
- State Key Laboratory of Cancer Biology and Experimental Teaching Center of Basic Medicine, Fourth Military Medical University, Xi’an, China
- *Correspondence: Jiaze An, ; Tingting Ren, ; Zheng Zhao,
| | - Yanheng Duan
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Haitao Guo
- State Key Laboratory of Cancer Biology and Department of Physiology and Pathophysiology, Fourth Military Medical University, Xi’an, China
| | - Gang Wang
- State Key Laboratory of Cancer Biology and Department of Physiology and Pathophysiology, Fourth Military Medical University, Xi’an, China
| | - Yu Gan
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Mengcai Bai
- State Key Laboratory of Cancer Biology and Experimental Teaching Center of Basic Medicine, Fourth Military Medical University, Xi’an, China
| | - Xiaotian Dong
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Zheng Zhao
- Third Department of Medical Oncology, Shaanxi Provincial Cancer Hospital, Xi’an, China
- *Correspondence: Jiaze An, ; Tingting Ren, ; Zheng Zhao,
| | - Jiaze An
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- *Correspondence: Jiaze An, ; Tingting Ren, ; Zheng Zhao,
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27
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Cassinotti E, Al-Taher M, Antoniou SA, Arezzo A, Baldari L, Boni L, Bonino MA, Bouvy ND, Brodie R, Carus T, Chand M, Diana M, Eussen MMM, Francis N, Guida A, Gontero P, Haney CM, Jansen M, Mintz Y, Morales-Conde S, Muller-Stich BP, Nakajima K, Nickel F, Oderda M, Parise P, Rosati R, Schijven MP, Silecchia G, Soares AS, Urakawa S, Vettoretto N. European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery. Surg Endosc 2023; 37:1629-1648. [PMID: 36781468 PMCID: PMC10017637 DOI: 10.1007/s00464-023-09928-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/28/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND In recent years, the use of Indocyanine Green (ICG) fluorescence-guided surgery during open and laparoscopic procedures has exponentially expanded across various clinical settings. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on this topic with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS An expert panel of surgeons has been selected and invited to participate to this project. Systematic reviews of the PubMed, Embase and Cochrane libraries were performed to identify evidence on potential benefits of ICG fluorescence-guided surgery on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by the panel; they were then submitted to all EAES members through a two-rounds online survey and results presented at the EAES annual congress, Barcelona, November 2021. RESULTS A total of 18,273 abstracts were screened with 117 articles included. 22 statements and 16 recommendations were generated and approved. In some areas, such as the use of ICG fluorescence-guided surgery during laparoscopic cholecystectomy, the perfusion assessment in colorectal surgery and the search for the sentinel lymph nodes in gynaecological malignancies, the large number of evidences in literature has allowed us to strongly recommend the use of ICG for a better anatomical definition and a reduction in post-operative complications. CONCLUSIONS Overall, from the systematic literature review performed by the experts panel and the survey extended to all EAES members, ICG fluorescence-guided surgery could be considered a safe and effective technology. Future robust clinical research is required to specifically validate multiple organ-specific applications and the potential benefits of this technique on clinical outcomes.
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Affiliation(s)
- E Cassinotti
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy.
| | - M Al-Taher
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - S A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - L Baldari
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - L Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - M A Bonino
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Brodie
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - T Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - M Chand
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - M Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - M M M Eussen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - A Guida
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - P Gontero
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - C M Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Y Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - B P Muller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Oderda
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - P Parise
- U.O.C. Chirurgia Generale, Policlinico di Abano Terme, Abano Terme, PD, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - M P Schijven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, North Holland, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
| | - G Silecchia
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A S Soares
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - S Urakawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - N Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Montichiari, Italy
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Lee LD, Hering NA, Zibell M, Lobbes LA, Kamphues C, Lauscher JC, Margonis GA, Seeliger H, Beyer K, Weixler B, Pozios I. Near-infrared Fluorescence Imaging for Detecting Pancreatic Liver Metastasis in an Orthotopic Athymic Mouse Model. In Vivo 2023; 37:519-523. [PMID: 36881105 PMCID: PMC10026647 DOI: 10.21873/invivo.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM Evidence of metastatic disease precludes oncological resection of pancreatic cancer. Near-infrared (NIR) fluorescent labels, such as indocyanine green (ICG), assist in the intraoperative detection of occult and micrometastatic liver disease. The present study aimed to analyse the role of NIR fluorescence imaging using ICG for pancreatic liver disease as proof of concept in an orthotopic athymic mouse model. MATERIALS AND METHODS Pancreatic ductal adenocarcinoma was induced by injecting L3.6pl human pancreatic tumour cells into the pancreatic tail of seven athymic mice. After four weeks of tumour growth, ICG was injected into the tail vein and NIR fluorescence imaging was performed at harvest to determine tumour-to-liver ratios (TLR) using Quest Spectrum® Fluorescence Imaging Platform. RESULTS Pancreatic tumour growth and liver metastasis could be visually confirmed for all seven animals. None of the hepatic metastases showed any detectable ICG-uptake. ICG-staining failed to visualize the liver metastases or to increase fluorescence intensity of the rim around the hepatic lesions. CONCLUSION ICG-staining fails to visualize liver metastases induced by L3.6pl pancreatic tumour cells in athymic nude mice by NIR fluorescence imaging. Further studies are necessary to delineate the underlying mechanism for insufficient ICG uptake in these pancreatic liver metastases and for the lack of a fluorescent rim around the liver lesions.
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Affiliation(s)
- Lucas D Lee
- Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of General, Visceral and Minimally Invasive Surgery, Park Klinik Weissensee, Berlin, Germany
| | - Nina A Hering
- Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Miriam Zibell
- Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Leonard A Lobbes
- Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carsten Kamphues
- Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of General, Visceral and Minimally Invasive Surgery, Park Klinik Weissensee, Berlin, Germany
| | - Johannes C Lauscher
- Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Georgios A Margonis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, U.S.A
| | | | - Katharina Beyer
- Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Benjamin Weixler
- Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ioannis Pozios
- Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany;
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Hardy NP, Epperlein JP, Dalli J, Robertson W, Liddy R, Aird JJ, Mulligan N, Neary PM, McEntee GP, Conneely JB, Cahill RA. Real-time administration of indocyanine green in combination with computer vision and artificial intelligence for the identification and delineation of colorectal liver metastases. Surg Open Sci 2023; 12:48-54. [PMID: 36936453 PMCID: PMC10017420 DOI: 10.1016/j.sopen.2023.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Fluorescence guided surgery for the identification of colorectal liver metastases (CRLM) can be better with low specificity and antecedent dosing impracticalities limiting indocyanine green (ICG) usefulness currently. We investigated the application of artificial intelligence methods (AIM) to demonstrate and characterise CLRMs based on dynamic signalling immediately following intraoperative ICG administration. Methods Twenty-five patients with liver surface lesions (24 CRLM and 1 benign cyst) undergoing open/laparoscopic/robotic procedures were studied. ICG (0.05 mg/kg) was administered with near-infrared recording of fluorescence perfusion. User-selected region-of-interest (ROI) perfusion profiles were generated, milestones relating to ICG inflow/outflow extracted and used to train a machine learning (ML) classifier. 2D heatmaps were constructed in a subset using AIM to depict whole screen imaging based on dynamic tissue-ICG interaction. Fluorescence appearances were also assessed microscopically (using H&E and fresh-frozen preparations) to provide tissue-level explainability of such methods. Results The ML algorithm correctly classified 97.2 % of CRLM ROIs (n = 132) and all benign lesion ROIs (n = 6) within 90-s of ICG administration following initial mathematical curve analysis identifying ICG inflow/outflow differentials between healthy liver and CRLMs. Time-fluorescence plots extracted for each pixel in 10 lesions enabled creation of 2D characterising heatmaps using flow parameters and through unsupervised ML. Microscopy confirmed statistically less CLRM fluorescence vs adjacent liver (mean ± std deviation signal/area 2.46 ± 9.56 vs 507.43 ± 160.82 respectively p < 0.001) with H&E diminishing ICG signal (n = 4). Conclusion ML accurately identifies CRLMs from surrounding liver tissue enabling representative 2D mapping of such lesions from their fluorescence perfusion patterns using AIM. This may assist in reducing positive margin rates at metastatectomy and in identifying unexpected/occult malignancies.
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Affiliation(s)
- Niall P. Hardy
- UCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland
| | | | - Jeffrey Dalli
- UCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland
| | - William Robertson
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Richard Liddy
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John J. Aird
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niall Mulligan
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter M. Neary
- Department of General and Colorectal Surgery, University Hospital Waterford, University College Cork, Ireland
| | - Gerard P. McEntee
- Department of Hepatobiliary, Foregut and Bariatric Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John B. Conneely
- Department of Hepatobiliary, Foregut and Bariatric Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ronan A. Cahill
- UCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- Corresponding author at: 47 Eccles Street, Dublin 7, Ireland. @Matersurgery
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Sebagh M, Desterke C, Feray C, Hamelin J, Habib M, Samuel D, Rosmorduc O, Vibert E, Golse N. Indocyanine green fluorescence patterns of hepatocellular carcinoma correlate with pathological and molecular features. HPB (Oxford) 2023; 25:198-209. [PMID: 36411232 DOI: 10.1016/j.hpb.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intraoperative Indocyanine Green Dye (ICG) routinely used in hepatobiliary surgery identifies different fluorescent patterns of hepatocellular carcinoma (HCC), a highly heterogeneous cancer. We aimed to correlate these patterns with gene mutations and extensive pathological features beyond the well-known tumor differentiation. METHODS Between February 2017 and December 2019, 21 HCC in 16 consecutive patients who underwent intraoperative ICG fluorescence imaging were included. Pathological review was performed by one pathologist blinded to fluorescence features. Random forest machine learning algorithm correlated pathological features of the tumor, peritumoral and non-tumoral liver, and gene mutations from a 28 gene-panel with rim and intra-lesion fluorescence. RESULTS Three HCC had negative intra-lesion and rim-like emission, 7 HCC had homogeneous pattern and 11 heterogeneous patterns in whom 3 with rim-like emission. Rim emission was associated with peritumoral vascular changes, lower differentiation and lower serum AFP level. Homogeneous intra-lesion fluorescence was associated with lower necrosis rate, thinner capsule, absence of peritumoral liver changes, and higher serum AFP level. Heterogeneous HCC without rim harbored lesser TP53 and ARID1A mutations. CONCLUSION Tumoral and peri-tumoral fluorescence classification of HCC yielded a possible intraoperative pathological and molecular characterization. These preliminary observations could lead to intraoperative refinement in surgical strategy.
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Affiliation(s)
- Mylène Sebagh
- AP-HP Hôpital Paul-Brousse, Laboratoire d'Anatomopathologie, Villejuif, F-94800, France; UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France.
| | - Christophe Desterke
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France
| | - Cyrille Feray
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
| | - Jocelyne Hamelin
- AP-HP Hôpital Paul-Brousse, Plateforme de biologie moléculaire, Villejuif, F-94800, France
| | - Myriam Habib
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
| | - Didier Samuel
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
| | - Olivier Rosmorduc
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
| | - Eric Vibert
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
| | - Nicolas Golse
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
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Pardo Aranda F, Gené Škrabec C, López-Sánchez J, Zarate Pinedo A, Espin Álvarez F, Cremades Pérez M, Navinés López J, Herrero Vicente C, Vidal Piñeiro L, Cugat Andorrà E. Indocyanine green (ICG) fluorescent cholangiography in laparoscopic cholecystectomy: Simplifying time and dose. Dig Liver Dis 2023; 55:249-253. [PMID: 36404235 DOI: 10.1016/j.dld.2022.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/15/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND This article aims to analyze and to simplify the optimal dose and time of intravenous indocyanine green (ICG) administration to achieve the identification of the cystic duct and the common bile duct (CBD). METHODS A consecutive series of 146 patients was prospectively analyzed and divided into three groups according to the time of ICG administration: at induction of anesthesia group (20-30 min); hours before group (between 2 and 6 h); and the day before group (≥6 h); and two groups according to the dose of ICG: 1 cc (2.5 mg) or weight-based dose (0.05 mg/kg). RESULTS The CBD was better visualized in the at induction of anesthesia group (85.4%), in the hours before group (97.1%) (p = 0.002) and in the 1cc group (p = 0.011). When we analyzed the 1 cc group (n = 126) a greater visualization of the CBD was observed in the at induction of anesthesia group (86.7%) and in the hours before group (97.1%) (p = 0.027). CONCLUSION Due to its simplicity and reproducibility, we suggest a dose of 2.5 mg administered 2-6 h before the procedure is the optimal. However, ICG administered 30 min prior to the surgery is enough for adequate visualization of biliary structures.
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Affiliation(s)
- Fernando Pardo Aranda
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Clara Gené Škrabec
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Jaime López-Sánchez
- Department of General and Digestive Surgery, Hospital Universitario de Salamanca, Spain
| | - Alba Zarate Pinedo
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Francisco Espin Álvarez
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Manel Cremades Pérez
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Jordi Navinés López
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Christian Herrero Vicente
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Laura Vidal Piñeiro
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Esteban Cugat Andorrà
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain; Department of General and Digestive Surgery, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
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Fadel MG, Ahmed M, Pellino G, Rasheed S, Tekkis P, Nicol D, Kontovounisios C, Mayer E. Retroperitoneal Lymph Node Dissection in Colorectal Cancer with Lymph Node Metastasis: A Systematic Review. Cancers (Basel) 2023; 15:455. [PMID: 36672404 PMCID: PMC9857277 DOI: 10.3390/cancers15020455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
The benefits and prognosis of RPLND in CRC have not yet been fully established. This systematic review aimed to evaluate the outcomes for CRC patients with RPLNM undergoing RPLND. A literature search of MEDLINE, EMBASE, EMCare, and CINAHL identified studies from between January 1990 and June 2022 that reported data on clinical outcomes for patients who underwent RPLND for RPLNM in CRC. The following primary outcome measures were derived: postoperative morbidity, disease free-survival (DFS), overall survival (OS), and re-recurrence. Nineteen studies with a total of 541 patients were included. Three hundred and sixty-three patients (67.1%) had synchronous RPLNM and 178 patients (32.9%) had metachronous RPLNM. Perioperative chemotherapy was administered in 496 (91.7%) patients. The median DFS was 8.6-38.0 months and 5-year DFS was 24.4% (10.0-60.5%). The median OS was 25.0-83.0 months and 5-year OS was 47.0% (15.0-87.5%). RPLND is a feasible treatment option with limited morbidity and possible oncological benefit for both synchronous and metachronous RPLNM in CRC. Further prospective clinical trials are required to establish a better evidence base for RPLND in the context of RPLNM in CRC and to understand the timing of RPLND in a multimodality pathway in order to optimise treatment outcomes for this group of patients.
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Affiliation(s)
- Michael G. Fadel
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
| | - Mosab Ahmed
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Colorectal Unit, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Shahnawaz Rasheed
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
- Department of Colorectal Surgery, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Paris Tekkis
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
- Department of Colorectal Surgery, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - David Nicol
- Department of Academic Urology, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
- Department of Colorectal Surgery, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Erik Mayer
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Department of Academic Urology, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
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Strigalev M, Tzedakis S, Nassar A, Dhote A, Gavignet C, Gaillard M, Marchese U, Fuks D. Intra-operative indocyanine green fluorescence imaging in hepatobiliary surgery: a narrative review of the literature as a useful guide for the surgeon. Updates Surg 2023; 75:23-29. [PMID: 36370332 DOI: 10.1007/s13304-022-01388-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In hepatobiliary surgery, intra-operative indocyanine green (ICG) fluorescence imaging use started in the late 2000s with Japanese surgical teams and is now gaining popularity among surgeons all over the world to improve accuracy and safety of surgical procedures. However, even if ICG fluorescence has been shown to be a safe imaging modality, only a few clinical efficacity studies have been performed and no guidance has been established. This narrative review aims at assessing the potential applications of ICG fluorescence imaging in hepatobiliary surgery. METHODS We screened the available international literature to identify the most used applications of ICG fluorescence imaging in hepatobiliary surgery. RESULTS Three main fields were identified: biliary duct visualization, hepatic segments' delimitation, and liver tumor detection. Comments, application protocols, prospects, and limitations of each technique were described. DISCUSSION These results could guide hepatobiliary surgeons in their use of ICG fluorescence imaging; nevertheless, further prospective studies are needed to assess the sensitivity and specificity of this modality.
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Affiliation(s)
- Marie Strigalev
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Hospital, AP-HP Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
- Faculté de Médecine, Université de Paris, 75006, Paris, France.
| | - Stylianos Tzedakis
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Hospital, AP-HP Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Faculté de Médecine, Université de Paris, 75006, Paris, France
| | - Alexandra Nassar
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Hospital, AP-HP Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Faculté de Médecine, Université de Paris, 75006, Paris, France
| | - Alix Dhote
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Hospital, AP-HP Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Faculté de Médecine, Université de Paris, 75006, Paris, France
| | - Chloe Gavignet
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Hospital, AP-HP Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Faculté de Médecine, Université de Paris, 75006, Paris, France
| | - Martin Gaillard
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Hospital, AP-HP Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Faculté de Médecine, Université de Paris, 75006, Paris, France
| | - Ugo Marchese
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Hospital, AP-HP Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Faculté de Médecine, Université de Paris, 75006, Paris, France
| | - David Fuks
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Hospital, AP-HP Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Faculté de Médecine, Université de Paris, 75006, Paris, France
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Fernandes JR, Dos Santos LCF, Lamers ML. Applicability of autofluorescence and fluorescent probes in the trans-surgical of oral carcinomas: A systematic review. Photodiagnosis Photodyn Ther 2022; 41:103238. [PMID: 36509404 DOI: 10.1016/j.pdpdt.2022.103238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022]
Abstract
Oral cancer represents an important health problem, as it is the sixth most common type of cancer in the world and is associated with high rates of morbidity and mortality. The treatment considered the gold standard for this type of tumor is surgical resection with negative margins, with a distance of at least 5 mm from the tumor. This procedure is strongly associated with local control and disease-specific survival, however, in many cases, large amounts of healthy tissue are removed, resulting in surgical defects, compromising various functions and directly affecting the individual's quality of life. From this perspective, this systematic review aimed to evaluate the use of autofluorescence and fluorescent probes as potential adjuvant techniques to facilitate the delineation of surgical margins for oral cancers. A comprehensive search was performed in Pubmed, Scopus, Web of Science, LIVIVO, Embase, ProQuest Open Access Dissertations & Theses, Open Access Theses and Dissertations, and DART Europe databases, where 1948 articles were found. After the different stages of critical evaluation, 15 articles were selected, eligible for the inclusion criteria. Of these, 7 articles used autofluorescence, 7 used fluorescent probes and 1 article used both methods. As for autofluorescence, the most used device was the VELScope, and indocyanine green was the most used probe. Compared to histopathology, autofluorescence did not obtain significant and/or superiors results. In contrast to fluorescent probes that, most articles showed a good performance of margins during surgical resection, making them a promising alternative. However, it is still necessary to carry out the analysis of more articles, with more significant samples and sensitivity and specificity data to qualify the results.
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Affiliation(s)
- Julia Rodrigues Fernandes
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Marcelo Lazzaron Lamers
- Department of Morphological Sciences, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2600, Porto Alegre, RS CEP 90035-003, Brazil.
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Singhal S, Azari F, Caponetti GC, Kennedy GT. Novel intraoperative near-infrared imaging strategy to identify abnormalities in the anterior mediastinum. J Cardiothorac Surg 2022; 17:302. [PMID: 36494869 PMCID: PMC9734605 DOI: 10.1186/s13019-022-02054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
Thoracic surgeons are frequently asked to biopsy suspicious tissues in the anterior mediastinum to discriminate between a reactive versus malignant pathology such as lymph nodes. The most common benign cause of a mediastinal lymph node is a reactive lymph node from a prior infection or inflammatory process such as post-COVID or granulomatous disease. The most common malignant cause is a lymphoproliferative disorder but also metastatic disease from neck, breast and other regional cancers. Biopsies in this location are challenging because they are far from the trachea and the sternum is a barrier to most diagnostic procedures. Thus, a surgical biopsy is frequently required and a common procedure for Thoracic surgeons. Technically, identifying these lesions can be challenging, particularly for small lesions or those in patients with high body mass index. In order to improve contrast between diseased tissue in the anterior mediastinum and surrounding adipose tissue, we have been studying near-infrared imaging during surgery using indocyanine green (ICG) to give contrast to the abnormal tissues and to avoid an unnecessary extended resection. We developed a modified technique to give ICG to a patient during a biopsy in the anterior mediastinum to specifically highlight abnormal tissues. As a proof-of-principle, we present a case of a young woman with a suspicious 2 cm mediastinal lymph node that required surgical biopsy.
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Affiliation(s)
- Sonia Singhal
- grid.25879.310000 0004 1936 8972Department of Surgery, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA USA
| | - Feredun Azari
- grid.25879.310000 0004 1936 8972Department of Surgery, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA USA
| | - Gabriel C. Caponetti
- grid.25879.310000 0004 1936 8972Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA USA
| | - Gregory T. Kennedy
- grid.25879.310000 0004 1936 8972Department of Surgery, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA USA ,grid.411115.10000 0004 0435 0884Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 USA
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Duan Y, Shen C, Zhang Y, Luo Y. Advanced diagnostic and therapeutic strategies in nanotechnology for lung cancer. Front Oncol 2022; 12:1031000. [PMID: 36568152 PMCID: PMC9767962 DOI: 10.3389/fonc.2022.1031000] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
As a highly invasive thoracic malignancy with increasing prevalence, lung cancer is also the most lethal cancer worldwide due to the failure of effective early detection and the limitations of conventional therapeutic strategies for advanced-stage patients. Over the past few decades, nanotechnology has emerged as an important technique to obtain desired features by modifying and manipulating different objects on a molecular level and gained a lot of attention in many fields of medical applications. Studies have shown that in lung cancer, nanotechnology may be more effective and specific than traditional methods for detecting extracellular cancer biomarkers and cancer cells in vitro, as well as imaging cancer in vivo; Nanoscale drug delivery systems have developed rapidly to overcome various forms of multi-drug resistance and reduce detrimental side effects to normal tissues by targeting cancerous tissue precisely. There is no doubt that nanotechnology has the potential to enhance healthcare systems by simplifying and improving cancer diagnostics and treatment. Throughout this review, we summarize and highlight recent developments in nanotechnology applications for lung cancer in diagnosis and therapy. Moreover, the prospects and challenges in the translation of nanotechnology-based diagnostic and therapeutic methods into clinical applications are also discussed.
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Affiliation(s)
- Yujuan Duan
- Department of Laboratory Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China,School of Chemical Science and Engineering, Tongji University, Shanghai, China,Department of Laboratory Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Shen
- Department of Laboratory Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yinan Zhang
- School of Chemical Science and Engineering, Tongji University, Shanghai, China,*Correspondence: Yao Luo, ; Yinan Zhang,
| | - Yao Luo
- Department of Laboratory Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Yao Luo, ; Yinan Zhang,
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Yamamoto Y, Shimizu T, Mori M, Okamatsu C, Nakamura N, Watanabe T. Rim-type indocyanine green fluorescence pattern in a child with undifferentiated embryonal sarcoma of the liver treated with navigation surgery. Pediatr Blood Cancer 2022; 69:e29799. [PMID: 35920603 DOI: 10.1002/pbc.29799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Yuki Yamamoto
- Department of Pediatric Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Takahiro Shimizu
- Department of Pediatric Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Masaharu Mori
- Department of Pediatric Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Chizuko Okamatsu
- Department of Pathology, Tokai University School of Medicine, Kanagawa, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Kanagawa, Japan
| | - Toshihiko Watanabe
- Department of Pediatric Surgery, Tokai University School of Medicine, Kanagawa, Japan
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Mehdizadeh Naderi P, Zargoosh K, Qandalee M, Firuzi O, Behmadi H, Hossienkhani S, Moasses Ghafary S, Durán-Valle CJ. Synthesis and application of the fluorescent furan and imidazole probes for selective in vivo and in vitro cancer cell imaging. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 279:121455. [PMID: 35679740 DOI: 10.1016/j.saa.2022.121455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
Development of imaging probes for identification of tumors in the early stages of growth can significantly reduce the tumor-related health hazards and improve our capacity for treatment of cancer. In this work, three different furan and imidazole fluorescent derivatives abbreviated as Cyclo X, SAC and SNO are introduced for in vivo and in vitro imaging of cancer cells. The fluorescence quantum yield values were 0.226, 0.400 and 0.479 for Cyclo X, SAC and SNO, respectively. The excitation and emission wavelengths of maximum intensity were (360, 452), (350, 428) and (350, 432) nm for Cyclo X, SAC and SNO, respectively. The MTT reduction assay was used to estimate the cytotoxic activity of the proposed derivatives against HT-29 (cancer) and Vero (normal) cell lines. Cyclo X showed no cytotoxic effect, while SAC and SNO showed significantly higher cytotoxicity against the tested cell lines than cisplatin as a well-known anticancer drug. In vitro fluorescence microscopic images obtained using HT-29 cells showed that Cyclo X produced very bright images. The in vivo cancer cell imaging using 4T1 tumor-bearing mice revealed that Cyclo X is selectively accumulated in the tumor without distribution in the mice body organs. The spectral and structural stability, large Stokes shift, non-cytotoxicity and high level of selectivity for in vivo imaging are properties that make Cyclo X a suitable candidate to be used for long-term monitoring of cancer cells.
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Affiliation(s)
- Parisa Mehdizadeh Naderi
- Department of Chemistry, Isfahan University of Technology, Isfahan 84156-83111, Islamic Republic of Iran
| | - Kiomars Zargoosh
- Department of Chemistry, Isfahan University of Technology, Isfahan 84156-83111, Islamic Republic of Iran.
| | - Mohammad Qandalee
- Department of Basic Sciences, Garmsar Branch, Islamic Azad University, Garmsar, Iran
| | - Omidreza Firuzi
- Medicinal and Natural Products Chemistry Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Behmadi
- Department of Chemistry, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Saman Hossienkhani
- Department of Biochemistry, Faculty of Biological Science, Tarbiat Modares University, Tehran, Iran
| | - Sorous Moasses Ghafary
- Department of Nanobiotechnology, Faculty of Biological Science, Tarbiat Modares University, Tehran, Iran
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Xu J, Han T, Wang Y, Zhang F, Li M, Bai L, Wang X, Sun B, Wang X, Du J, Liu K, Zhang J, Zhu S. Ultrabright Renal-Clearable Cyanine-Protein Nanoprobes for High-Quality NIR-II Angiography and Lymphography. NANO LETTERS 2022; 22:7965-7975. [PMID: 36165293 DOI: 10.1021/acs.nanolett.2c03311] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The renal-clearable aspect of imaging agent with minimum toxicity issues and side effects is essential for clinical translation, yet clinical near-infrared-I/II (NIR-I/II) fluorophores with timely renal-clearance pathways are very limited. Herein, we rationally develop the cyanine-protein composite strategy through covalent bonding of β-lactoglobulin (β-LG) and chloride-cyanine dye to produce a brilliant and stable NIR-I/II fluorophore (e.g., β-LG@IR-780). The β-LG acts as a protecting shell with small molecular weight (18.4 kDa) and ultrasmall size (<5 nm), thus endowing the β-LG@IR-780 with excellent biocompatibility and renal excretion. Our β-LG@IR-780 probe enables noninvasive and precise NIR-II visualization of the physiological and pathological conditions of the vascular and lymphatic drainage system, facilitating intraoperative imaging-guided surgery and postoperative noninvasive monitoring. The minimum accumulation of our probes in the main organs improves the overall biosafety. This study provides a facile methodology for new-generation NIR-II fluorophores and largely improves the brightness and pharmacokinetics of small molecular dyes.
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Affiliation(s)
- Jiajun Xu
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Tianyang Han
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Yajun Wang
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Feiran Zhang
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Mengfei Li
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Lang Bai
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China
| | - Xinyu Wang
- China-Japan Union Hospital of Jilin University, Key Laboratory of Lymphatic Surgery Jilin Province, Jilin Engineering Laboratory for Lymphatic Surgery Jilin Province, Changchun 130031, P. R. China
| | - Bin Sun
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun 130021, P.R. China
| | - Xin Wang
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun 130021, P.R. China
| | - Jianshi Du
- China-Japan Union Hospital of Jilin University, Key Laboratory of Lymphatic Surgery Jilin Province, Jilin Engineering Laboratory for Lymphatic Surgery Jilin Province, Changchun 130031, P. R. China
| | - Kun Liu
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun 130021, P.R. China
| | - Junhu Zhang
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun 130021, P.R. China
| | - Shoujun Zhu
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun 130021, P.R. China
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Sposito C, Maspero M, Belotti P, Simonotti N, Altomare M, Ciana P, Mazzaferro V. Indocyanine Green Fluorescence-Guided Surgery for Gastrointestinal Tumors: A Systematic Review. ANNALS OF SURGERY OPEN 2022; 3:e190. [PMID: 37601143 PMCID: PMC10431291 DOI: 10.1097/as9.0000000000000190] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To conduct a systematic review of the currently available literature on the use of ICG to guide surgical dissection in gastrointestinal (GI) cancer surgery. Background Real-time indocyanine green (ICG) fluorescence-guided surgery has the potential to enhance surgical outcomes by increasing patient-tailored oncological precision. Methods MEDLINE, PubMed, EMBASE, and Google Scholar were searched for publications on the use of ICG as a contrast agent in GI cancer surgery until December 2020. Perfusion studies were excluded. Quality of the studies was assessed with the Methodological Index for nonrandomized Studies or Jadad scale for randomized controlled trials. A narrative synthesis of the results was provided, with descriptive statistics when appropriate. Results Seventy-eight studies were included. ICG was used for primary tumor and metastases localization, for sentinel lymph node detection, and for lymph flow mapping. The detection rate for primary colorectal and gastric tumors was 100% after preoperative ICG endoscopic injection. For liver lesions, the detection rate after intravenous ICG infusion was 80% and up to 100% for lesions less than 8 mm from the liver surface. The detection rate for sentinel lymph nodes was 89.8% for esophageal, 98.6% for gastric, 87.4% for colorectal, and 83.3% for anal tumors, respectively. In comparative studies, ICG significantly increases the quality of D2 lymphadenectomy in oncological gastrectomy. Conclusion The use of ICG as a guiding tool for dissection in GI surgery is promising. Further evidence from high-quality studies on larger sample sizes is needed to assess whether ICG-guided surgery may become standard of care.
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Affiliation(s)
- Carlo Sposito
- From the General Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Marianna Maspero
- From the General Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- University of Milan, Milan, Italy
| | | | | | | | - Paolo Ciana
- Department of Health Sciences, Institute of Pharmacology, University of Milan, Milan, Italy
| | - Vincenzo Mazzaferro
- From the General Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Mehdorn AS, Richter F, Hess K, Beckmann JH, Egberts JH, Linecker M, Becker T, Braun F. The Role of ICG in Robot-Assisted Liver Resections. J Clin Med 2022; 11:3527. [PMID: 35743595 PMCID: PMC9225074 DOI: 10.3390/jcm11123527] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction: Robotic-assisted liver surgery (RALS) with its known limitations is gaining more importance. The fluorescent dye, indocyanine green (ICG), is a way to overcome some of these limitations. It accumulates in or around hepatic masses. The integrated near-infrared cameras help to visualize this accumulation. We aimed to compare the influence of ICG staining on the surgical and oncological outcomes in patients undergoing RALS. Material and Methods: Patients who underwent RALS between 2014 and 2021 at the Department of General Surgery at the University Hospital Schleswig-Holstein, Campus Kiel, were included. In 2019, ICG-supported RALS was introduced. Results: Fifty-four patients were included, with twenty-eight patients (50.9%) receiving preoperative ICG. Hepatocellular carcinoma (32.1%) was the main entity resected, followed by the metastasis of colorectal cancers (17%) and focal nodular hyperplasia (15.1%). ICG staining worked for different tumor entities, but diffuse staining was noted in patients with liver cirrhosis. However, ICG-supported RALS lasted shorter (142.7 ± 61.8 min vs. 246.4 ± 98.6 min, p < 0.001), tumors resected in the ICG cohort were significantly smaller (27.1 ± 25.0 mm vs. 47.6 ± 35.2 mm, p = 0.021) and more R0 resections were achieved by ICG-supported RALS (96.3% vs. 80.8%, p = 0.075). Conclusions: ICG-supported RALS achieve surgically and oncologically safe results, while overcoming the limitations of RALS.
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Affiliation(s)
- Anne-Sophie Mehdorn
- Department of General, Abdominal, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; (A.-S.M.); (F.R.); (J.H.B.); (M.L.); (T.B.)
| | - Florian Richter
- Department of General, Abdominal, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; (A.-S.M.); (F.R.); (J.H.B.); (M.L.); (T.B.)
| | - Katharina Hess
- Department of Pathology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany;
| | - Jan Henrik Beckmann
- Department of General, Abdominal, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; (A.-S.M.); (F.R.); (J.H.B.); (M.L.); (T.B.)
| | - Jan-Hendrik Egberts
- Department of Surgery, Israelit Hospital, Orchideenstieg 14, 22297 Hamburg, Germany;
| | - Michael Linecker
- Department of General, Abdominal, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; (A.-S.M.); (F.R.); (J.H.B.); (M.L.); (T.B.)
| | - Thomas Becker
- Department of General, Abdominal, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; (A.-S.M.); (F.R.); (J.H.B.); (M.L.); (T.B.)
| | - Felix Braun
- Department of General, Abdominal, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; (A.-S.M.); (F.R.); (J.H.B.); (M.L.); (T.B.)
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Choi JH, Kang CM, Park JY. EGFR-targeted fluorescent imaging using the da Vinci® Firefly™ camera for gallbladder cancer. World J Surg Oncol 2022; 20:201. [PMID: 35701793 PMCID: PMC9199159 DOI: 10.1186/s12957-022-02675-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background Fluorescent imaging may aid with the precise diagnosis and treatment of patients with gallbladder cancer. In this study, we sought to demonstrate whether the da Vinci® surgical system and Firefly™ camera could detect EGFR-targeted fluorescent images in orthotopic mouse models of gallbladder cancer. Methods An orthotopic mouse model of gallbladder cancer was created by injecting NOZ gallbladder cancer cells mixed with Matrigel into the gallbladder. In vivo imaging of subcutaneous and orthotopic gallbladder tumors was performed after the injection of DyLight 650- or 800-conjugated EGFR antibody. Results Western blotting, flow cytometry, and confocal microscopy showed the presence of EGFR in NOZ cells, but not in HEK293 cells. Subcutaneous NOZ cell tumors fluoresced after injection with fluorescent EGFR antibody, but subcutaneous HEK293 tumors did not. Fluorescent EGFR antibody made orthotopic NOZ tumors fluoresce, with an intensity stronger than that in the surrounding normal tissues. Histochemical examination confirmed the location of the tumors inside the gallbladder and adjacent liver parenchyma. Fluorescent signal was also detected in orthotopic gallbladder tumors with Firefly™ camera. Conclusion Our study showed that fluorescent EGFR antibodies and the Firefly camera in the da Vinci system can detect fluorescing gallbladder tumors, which demonstrates their potential use for molecular imaging-based prevision surgery in the near future.
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Affiliation(s)
- Jung Ha Choi
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Moo Kang
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Pancreatobiliary Cancer Center, Yonsei Cancer Center, and Yonsei Institute of Gastroenterology, Severance Hospital, Seoul, South Korea
| | - Jeong Youp Park
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Pancreatobiliary Cancer Center, Yonsei Cancer Center, and Yonsei Institute of Gastroenterology, Severance Hospital, Seoul, South Korea.
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Ayabe RI, Azimuddin A, Tran Cao HS. Robot-assisted liver resection: the real benefit so far. Langenbecks Arch Surg 2022; 407:1779-1787. [PMID: 35488913 DOI: 10.1007/s00423-022-02523-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Minimally invasive liver resection is associated with lower perioperative morbidity and shorter hospital stay. However, the added benefit of the robotic platform over conventional laparoscopy is a matter of ongoing investigation. PURPOSE The purpose of this narrative review is to provide an up-to-date and balanced evaluation of the benefits and shortcomings of robotic liver surgery for the modern hepatobiliary surgeon. CONCLUSIONS Advantages of a robotic approach to liver resection include a shortened learning curve, the ability to complete more extensive or complex minimally invasive operations, and integrated fluorescence guidance. However, the robotic platform remains limited by a paucity of parenchymal transection devices, complete lack of haptic feedback, and added operating time associated with docking and instrument exchange. Like laparoscopic hepatectomy, robotic hepatectomy may provide patients with more rapid recovery and a shorter hospital stay, which can help offset the substantial costs of robot acquisition and maintenance. The oncologic outcomes of robotic hepatectomy appear to be equivalent to laparoscopic and open hepatectomy for appropriately selected patients.
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Affiliation(s)
- Reed I Ayabe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Ahad Azimuddin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA.
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Gaitan B, Frankel L, Vig S, Oskoui E, Adwan M, Chen Y, Elespuru R, Huang HC, Pfefer TJ. Quantifying the Photochemical Damage Potential of Contrast-Enhanced Fluorescence Imaging Products: Singlet Oxygen Production. Photochem Photobiol 2022; 98:736-747. [PMID: 35442536 PMCID: PMC9540578 DOI: 10.1111/php.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/17/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
The benefits of contrast‐enhancing imaging probes have become apparent over the past decade. However, there is a gap in the literature when it comes to the assessment of the phototoxic potential of imaging probes and systems emitting visible and/or near‐infrared radiation. The primary mechanism of fluorescent agent phototoxicity is thought to involve the production of reactive molecular species (RMS), yet little has been published on the best practices for safety evaluation of RMS production levels for clinical products. We have proposed methods involving a cell‐free assay to quantify singlet oxygen [(SO) a known RMS] generation of imaging probes, and performed testing of Indocyanine Green (ICG), Proflavine, Methylene Blue, IR700 and IR800 at clinically relevant concentrations and radiant exposures. Results indicated that SO production from IR800 and ICG were more than two orders of magnitude below that of the known SO generator Rose Bengal. Methylene Blue and IR700 produced much higher SO levels than ICG and IR800. These results were in good agreement with data from the literature. While agents that exhibit spectral overlap with the assay may be more prone to errors, our tests for one of these agents (Proflavine) appeared robust. Overall, our results indicate that this methodology shows promise for assessing the phototoxic potential of fluorophores due to SO production.
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Affiliation(s)
- Brandon Gaitan
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Lucas Frankel
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Shruti Vig
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Ellen Oskoui
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD, USA
| | - Miriam Adwan
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Yu Chen
- Department of Biomedical Engineering, University of Massachusetts-Amherst, Amherst, MA, USA
| | - Rosalie Elespuru
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD, USA
| | - Huang Chiao Huang
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - T Joshua Pfefer
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD, USA
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Wang F, Qu L, Ren F, Baghdasaryan A, Jiang Y, Hsu R, Liang P, Li J, Zhu G, Ma Z, Dai H. High-precision tumor resection down to few-cell level guided by NIR-IIb molecular fluorescence imaging. Proc Natl Acad Sci U S A 2022; 119:e2123111119. [PMID: 35380898 PMCID: PMC9169804 DOI: 10.1073/pnas.2123111119] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/03/2022] [Indexed: 12/19/2022] Open
Abstract
In vivo fluorescence/luminescence imaging in the near-infrared-IIb (NIR-IIb, 1,500 to 1,700 nm) window under <1,000 nm excitation can afford subcentimeter imaging depth without any tissue autofluorescence, promising high-precision intraoperative navigation in the clinic. Here, we developed a compact imager for concurrent visible photographic and NIR-II (1,000 to 3,000 nm) fluorescence imaging for preclinical image-guided surgery. Biocompatible erbium-based rare-earth nanoparticles (ErNPs) with bright down-conversion luminescence in the NIR-IIb window were conjugated to TRC105 antibody for molecular imaging of CD105 angiogenesis markers in 4T1 murine breast tumors. Under a ∼940 ± 38 nm light-emitting diode (LED) excitation, NIR-IIb imaging of 1,500- to 1,700-nm emission afforded noninvasive tumor–to–normal tissue (T/NT) signal ratios of ∼40 before surgery and an ultrahigh intraoperative tumor-to-muscle (T/M) ratio of ∼300, resolving tumor margin unambiguously without interfering background signal from surrounding healthy tissues. High-resolution imaging resolved small numbers of residual cancer cells during surgery, allowing thorough and nonexcessive tumor removal at the few-cell level. NIR-IIb molecular imaging afforded 10-times-higher and 100-times-higher T/NT and T/M ratios, respectively, than imaging with IRDye800CW-TRC105 in the ∼900- to 1,300-nm range. The vastly improved resolution of tumor margin and diminished background open a paradigm of molecular imaging-guided surgery.
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Affiliation(s)
- Feifei Wang
- Department of Chemistry, Stanford University, Stanford, CA 94305
- Bio-X, Stanford University, Stanford, CA 94305
| | - Liangqiong Qu
- School of Medicine, Stanford University, Stanford, CA 94303
| | - Fuqiang Ren
- Department of Chemistry, Stanford University, Stanford, CA 94305
- Bio-X, Stanford University, Stanford, CA 94305
| | - Ani Baghdasaryan
- Department of Chemistry, Stanford University, Stanford, CA 94305
- Bio-X, Stanford University, Stanford, CA 94305
| | - Yingying Jiang
- Department of Chemistry, Stanford University, Stanford, CA 94305
- Bio-X, Stanford University, Stanford, CA 94305
| | - RuSiou Hsu
- Department of Chemistry, Stanford University, Stanford, CA 94305
- Bio-X, Stanford University, Stanford, CA 94305
| | - Peng Liang
- Department of Chemistry, Stanford University, Stanford, CA 94305
- Bio-X, Stanford University, Stanford, CA 94305
| | - Jiachen Li
- Department of Chemistry, Stanford University, Stanford, CA 94305
- Bio-X, Stanford University, Stanford, CA 94305
| | - Guanzhou Zhu
- Department of Chemistry, Stanford University, Stanford, CA 94305
- Bio-X, Stanford University, Stanford, CA 94305
| | - Zhuoran Ma
- Department of Chemistry, Stanford University, Stanford, CA 94305
- Bio-X, Stanford University, Stanford, CA 94305
| | - Hongjie Dai
- Department of Chemistry, Stanford University, Stanford, CA 94305
- Bio-X, Stanford University, Stanford, CA 94305
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Fluoreszenzbildgebung mit Indocyaningrün (ICG) in der Chirurgie von kolorektalen Lebermetastasen. COLOPROCTOLOGY 2022. [DOI: 10.1007/s00053-022-00590-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saito Y, Shimada M, Morine Y, Yamada S, Sugimoto M. Essential updates 2020/2021: Current topics of simulation and navigation in hepatectomy. Ann Gastroenterol Surg 2022; 6:190-196. [PMID: 35261944 PMCID: PMC8889864 DOI: 10.1002/ags3.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 01/01/2023] Open
Abstract
With the development of three-dimensional (3D) simulation software, preoperative simulation technology is almost completely established. The remaining issue is how to recognize anatomy three-dimensionally. Extended reality is a newly developed technology with several merits for surgical application: no requirement for a sterilized display monitor, better spatial awareness, and the ability to share 3D images among all surgeons. Various technology or devices for intraoperative navigation have also been developed to support the safety and certainty of liver surgery. Consensus recommendations regarding indocyanine green fluorescence were determined in 2021. Extended reality has also been applied to intraoperative navigation, and artificial intelligence (AI) is one of the topics of real-time navigation. AI might overcome the problem of liver deformity with automatic registration. Including the issues described above, this article focuses on recent advances in simulation and navigation in liver surgery from 2020 to 2021.
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Affiliation(s)
- Yu Saito
- Department of SurgeryTokushima UniversityTokushimaJapan
| | | | - Yuji Morine
- Department of SurgeryTokushima UniversityTokushimaJapan
| | | | - Maki Sugimoto
- Department of SurgeryTokushima UniversityTokushimaJapan
- Okinaga Research InstituteTeikyo UniversityChiyoda‐kuJapan
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48
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Daniluk P, Mazur N, Swierblewski M, Chand M, Diana M, Polom K. Fluorescence Imaging in Colorectal Surgery: An Updated Review and Future Trends. Surg Innov 2022; 29:479-487. [PMID: 35232304 DOI: 10.1177/15533506211072678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fluorescence imaging in colorectal surgery is considered a novel predominantly intraoperative method of ensuring a greater surgical success. The use of fluorescence is linked to advanced tumor visualization and projection of its lymphatics, both vessels and nodes, which results in a higher chance of achieving a total excision. Additionally, iatrogenic complications prove to be reduced using fluorescence during the surgical excision. The combination of fluorescence and artificial intelligence to better facilitate oncological surgery will soon become an established approach in operating rooms worldwide.
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Affiliation(s)
- Paulina Daniluk
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Natalia Mazur
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Maciej Swierblewski
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Manish Chand
- Department of Surgery and Interventional Sciences, GENIE Centre, 4919University College London, University College London Hospitals, NHS Trust, London, UK
| | - Michele Diana
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Karol Polom
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
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Piccolo G, Barabino M, Pesce A, Diana M, Lecchi F, Santambrogio R, Opocher E, Bianchi PP, Piozzi GN. Role of Indocyanine Green Fluorescence Imaging in Minimally Invasive Resection of Colorectal Liver Metastases. Surg Laparosc Endosc Percutan Tech 2022; 32:259-265. [PMID: 35180735 DOI: 10.1097/sle.0000000000001037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/15/2021] [Indexed: 02/07/2023]
Abstract
Indocyanine green (ICG) fluorescence imaging is an easy and reproducible method to detect hepatic lesions, both primary and metastatic. This review reports the potential benefits of this technique as a tactile mimicking visual tool and a navigator guide in minimally invasive liver resection of colorectal liver metastases (CRLM). PubMed and MEDLINE databases were searched for studies reporting the use of intravenous injection of ICG before minimally invasive surgery for CLRM. The search was performed for publications reported from the first study in 2014 to April 2021. The final review included 13 articles: 6 prospective cohort studies, 1 retrospective cohort study, 3 case series, 1 case report, 1 case-matched study, and 1 clinical trial registry. The administered dose ranged between 0.3 and 0.5 mg/kg, while timing ranged between 1 and 14 days before surgery. CRLM detection rate ranged between 30.3% and 100% with preoperative imaging (abdominal computed tomography/magnetic resonance imaging), between 93.3 and 100% with laparoscopic ultrasound, between 57.6% and 100% with ICG fluorescence, and was 100% with combined modalities (ICG and laparoscopic ultrasound) with weighted averages of 77.42%, 95.97%, 79.03%, and 100%, respectively. ICG fusion imaging also allowed to detect occult small-sized lesions, not diagnosed preoperatively. In addition, ICG is effective in real-time assessment of surgical margins by evaluating the integrity of the fluorescent rim around the CRLM.
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Affiliation(s)
- Gaetano Piccolo
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences
| | - Matteo Barabino
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences
| | - Antonio Pesce
- Unit of General Surgery, University of Ferrara, Azienda USL di Ferrara, Lagosanto (FE), Italy
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer
- Department of General, Digestive, Endocrine Surgery, University Hospital of Strasbourg
- ICube Laboratory, Photonics for Health, University of Strasbourg, Strasbourg, France
| | | | - Roberto Santambrogio
- Unit of General Surgery, ASST Fatebenefratelli Sacco: Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Milan
| | - Enrico Opocher
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences
| | - Paolo P Bianchi
- Division of General and Robotic Surgery, Department of Health Sciences, University of Milan, San Paolo Hospital
| | - Guglielmo N Piozzi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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50
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Knospe L, Gockel I, Jansen-Winkeln B, Thieme R, Niebisch S, Moulla Y, Stelzner S, Lyros O, Diana M, Marescaux J, Chalopin C, Köhler H, Pfahl A, Maktabi M, Park JH, Yang HK. New Intraoperative Imaging Tools and Image-Guided Surgery in Gastric Cancer Surgery. Diagnostics (Basel) 2022; 12:diagnostics12020507. [PMID: 35204597 PMCID: PMC8871069 DOI: 10.3390/diagnostics12020507] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 02/05/2023] Open
Abstract
Innovations and new advancements in intraoperative real-time imaging have gained significant importance in the field of gastric cancer surgery in the recent past. Currently, the most promising procedures include indocyanine green fluorescence imaging (ICG-FI) and hyperspectral imaging or multispectral imaging (HSI, MSI). ICG-FI is utilized in a broad range of clinical applications, e.g., assessment of perfusion or lymphatic drainage, and additional implementations are currently investigated. HSI is still in the experimental phase and its value and clinical relevance require further evaluation, but initial studies have shown a successful application in perfusion assessment, and prospects concerning non-invasive tissue and tumor classification are promising. The application of machine learning and artificial intelligence technologies might enable an automatic evaluation of the acquired image data in the future. Both methods facilitate the accurate visualization of tissue characteristics that are initially indistinguishable for the human eye. By aiding surgeons in optimizing the surgical procedure, image-guided surgery can contribute to the oncologic safety and reduction of complications in gastric cancer surgery and recent advances hold promise for the application of HSI in intraoperative tissue diagnostics.
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Affiliation(s)
- Luise Knospe
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
- Correspondence:
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
- Department of General, Visceral and Oncological Surgery, St. Georg Hospital, 04129 Leipzig, Germany
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Stefan Niebisch
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Sigmar Stelzner
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Michele Diana
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.D.); (J.M.)
- ICUBE Laboratory, Photonics Instrumentation for Health, University of Strasbourg, 67400 Strasbourg, France
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 67091 Strasbourg, France
| | - Jacques Marescaux
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.D.); (J.M.)
| | - Claire Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Annekatrin Pfahl
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Marianne Maktabi
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Ji-Hyeon Park
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea; (J.-H.P.); (H.-K.Y.)
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea; (J.-H.P.); (H.-K.Y.)
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