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Kalayarasan R, Chandrasekar M, Sai Krishna P, Shanmugam D. Indocyanine green fluorescence in gastrointestinal surgery: Appraisal of current evidence. World J Gastrointest Surg 2023; 15:2693-2708. [PMID: 38222003 PMCID: PMC10784830 DOI: 10.4240/wjgs.v15.i12.2693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/12/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] Open
Abstract
Applying indocyanine green (ICG) fluorescence in surgery has created a new dimension of navigation surgery to advance in various disciplines. The research in this field is nascent and fragmented, necessitating academic efforts to gain a comprehensive understanding. The present review aims to integrate diverse perspectives and recent advances in its application in gastrointestinal surgery. The relevant articles were selected by using the appropriate keyword search in PubMed. The angiography and cholangiography property of ICG fluorescence is helpful in various hepatobiliary disorders. In gastroesophageal and colorectal surgery, the lymphangiography and angiography property of ICG is applied to evaluate bowel vascularity and guide lymphadenectomy. The lack of objective parameters to assess ICG fluorescence has been the primary limitation when ICG is used to evaluate bowel perfusion. The optimum dose and timing of ICG administration need to be standardized in some new application areas in gastrointestinal surgery. Binding tumor-specific ligands with fluorophores can potentially widen the fluorescence application to detect primary and metastatic gastrointestinal tumors. The narrative review outlines prior contributions, limitations, and research opportunities for future studies across gastrointestinal sub-specialty. The findings of the present review would be helpful for scholars and practitioners to explore and progress in this exciting domain of gastrointestinal surgery.
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Affiliation(s)
- Raja Kalayarasan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Murugesan Chandrasekar
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Pothugunta Sai Krishna
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Dasarathan Shanmugam
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
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Dezzani EO. Minimally invasive surgery: an overview. Minerva Surg 2023; 78:616-625. [PMID: 38059439 DOI: 10.23736/s2724-5691.23.10126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
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Piccolo G, Barabino M, Santambrogio R, Lecchi F, Di Gioia G, Opocher E, Bianchi PP. Correlation Between Indocyanine Green Fluorescence Patterns and Grade of Differentiation of Hepatocellular Carcinoma: A Western Prospective Cohort Study. Surg Innov 2023; 30:770-778. [PMID: 36840625 DOI: 10.1177/15533506231157171] [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: 02/26/2023]
Abstract
Background. Most of the available evidence on the use of indocyanine green (ICG) fluorescence in clinical practice consists of articles published by surgeons of the Asian-Pacific area. We performed a prospective cohort study to assess the patterns of ICG fluorescence in Western hepatocellular carcinoma (HCC) counterparts.Methods. From April 2019 to January 2022, a total of 31 consecutive patients who underwent laparoscopic liver resection (LLR) for superficial HCC were enrolled in this prospective study. All patients underwent laparoscopic staging with both laparoscopic ultrasound (LUS) and ICG fluorescence imaging.Results. A total of 38 hepatocellular carcinomas (HCCs) were enrolled: 23 superficial (surfacing at the liver's Glissonian capsule), 5 exophytic, 5 shallow (<8 mm from the hepatic surface) and 5 deep (>10 mm from the hepatic surface). The detection rate with preoperative imaging (abdominal CT/MRI), LUS, ICG fluorescence and combined modalities (ICG and LUS) was 97.4%, 94.9%, 89.7% and 100%, respectively. The five deep seated lesions underwent ultrasound-guided laparoscopic thermal ablation. The other 33 HCCs were treated with minimally invasive liver resection. Intraoperative ultrasound patterns were registered for each single nodule resected. The ICG fluorescence pattern was classified in two types: total fluorescence (all the tumoral tissue showed strong and homogeneous fluorescence), n = 9/33 (27.3%), and non-total fluorescence (partial and rim fluorescence), n = 24/33 (72.7%). There was a statistical correlation between ICG patterns and grade of differentiation. Almost all lesions with uniform fluorescence pattern were well-differentiated HCCs (G1-G2), while partial and rim-type fluorescence pattern were more common among moderately and poorly differentiated HCCs (G3-G4) (88.9% vs 11.1%, 37.5% vs 62.5%, P = .025, respectively).Conclusions. ICG fluorescence imaging could be used to identify early the grade of HCC, ie intraoperatively, thus influencing the intraoperative treatment.
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Affiliation(s)
- Gaetano Piccolo
- General Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Matteo Barabino
- General Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Francesca Lecchi
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Giulio Di Gioia
- General Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Enrico Opocher
- General Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Paolo Pietro Bianchi
- General Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
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Saruwatari MS, Jawed K, Ali KM, Ning B, Naik S, Nam SH, Schnermann MJ, Sandler A, Cha RJ. Assessment of a novel biliary-specific near-infrared fluorescent dye (BL-760) for intraoperative detection of bile ducts and biliary leaks during hepatectomy in a preclinical swine model. Lasers Surg Med 2023; 55:480-489. [PMID: 37003294 PMCID: PMC10330211 DOI: 10.1002/lsm.23661] [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: 12/25/2022] [Revised: 02/24/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES Postoperative bile leakage is a common complication of hepatobiliary surgery and frequently requires procedural intervention. Bile-label 760 (BL-760), a novel near-infrared dye, has emerged as a promising tool for identifying biliary structures and leakage, owing to its rapid excretion and strong bile specificity. This study aimed to assess the intraoperative detection of biliary leakage using intravenously administered BL-760 compared with intravenous (IV) and intraductal (ID) indocyanine green (ICG). MATERIALS AND METHODS Laparotomy and segmental hepatectomy with vascular control were performed on two 25-30 kg pigs. ID ICG, IV ICG, and IV BL-760 were administered separately, followed by an examination of the liver parenchyma, cut liver edge, and extrahepatic bile ducts for areas of leakage. The duration of intra- and extrahepatic fluorescence detection was assessed, and the target-to-background (TBR) of the bile ducts to the liver parenchyma was quantitatively measured. RESULTS In Animal 1, after intraoperative BL-760 injection, three areas of leaking bile were identified within 5 min on the cut liver edge with a TBR of 2.5-3.8 that was not apparent to the naked eye. In contrast, after IV ICG administration, the background parenchymal signal and bleeding obscured the areas of bile leakage. A second dose of BL-760 demonstrated the utility of repeated injections, confirming two of the three previously visualized areas of bile leakage and revealing one previously unseen leak. In Animal 2, neither ID ICG nor IV BL-760 injections showed obvious areas of bile leakage. However, fluorescence signals were observed within the superficial intrahepatic bile ducts after both injections. CONCLUSIONS BL-760 enables the rapid intraoperative visualization of small biliary structures and leaks, with the benefits of fast excretion, repeatable intravenous administration, and high-fluorescence TBR in the liver parenchyma. Potential applications include the identification of bile flow in the portal plate, biliary leak or duct injury, and postoperative monitoring of drain output. A thorough assessment of the intraoperative biliary anatomy could limit the need for postoperative drain placement, a possible contributor to severe complications and postoperative bile leak.
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Affiliation(s)
- Michele S Saruwatari
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC 20010, USA
- Department of Surgery, MedStar Georgetown University Hospital and Washington Hospital Center, Washington, DC 20010, USA
| | - Kochai Jawed
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC 20010, USA
| | - Khalid Mohamed Ali
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC 20010, USA
| | - Bo Ning
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC 20010, USA
| | - Sailee Naik
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC 20010, USA
| | - So-Hyun Nam
- Department of Surgery, Inje Paik Hospital, Busan, South Korea
| | - Martin J Schnermann
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD 21702
| | - Anthony Sandler
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC 20010, USA
- Joseph E. Robert, Jr. Center for Surgical Care, Children’s National Medical Center, Washington, DC 20010, USA
- George Washington School of Medicine and Health Sciences, Washington, DC 20052
| | - Richard Jaepyeong Cha
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC 20010, USA
- George Washington School of Medicine and Health Sciences, Washington, DC 20052
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Sasaki N, Okamura Y, Nishitai R. Real-Time Fluorescent Cholangiography by Intrabiliary Indocyanine Green Administration With Near-Infrared Laparoscopy in Major Hepatectomy. Cureus 2023; 15:e40769. [PMID: 37485116 PMCID: PMC10362199 DOI: 10.7759/cureus.40769] [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] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND AND PURPOSE Biliary injury is a severe complication that can be associated with liver surgery. Intrahepatic biliary anatomy can be evaluated using magnetic resonance cholangiopancreatography and X-ray cholangiography; however, an intraoperative real-time bile duct visualization method has not yet been reported. This study aimed to demonstrate the availability of real-time fluorescent cholangiography (FC) by intrabiliary indocyanine green administration with near-infrared laparoscopy in major hepatectomy. METHODS The optimal concentration of indocyanine green (ICG) solution was examined ex vivo. The fluorescence intensity of the ICG solution and its mixture with bile was measured. Using a clinical trial model, ICG solution was injected into the cystic duct, followed by near-infrared laparoscopy performed during hepatectomy. RESULTS The optimal concentration of ICG solution for FC was between 0.01 and 0.05 mg/mL. Three different laparoscopic systems were used in three hepatectomy cases. In all cases, the fluorescence of the intrahepatic bile ducts in the Glissonian sheath was clearly visualized using the near-infrared laparoscopic system. A small piece of tissue prevented the bile glow; thus, exposure of the Glissonian sheath was necessary for clear FC. This procedure also detected bile leakage from the cut surface of the liver. CONCLUSIONS Intrabiliary ICG administration and near-infrared laparoscopy enabled real-time intrahepatic FC during major hepatectomy.
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Affiliation(s)
- Naoya Sasaki
- Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, JPN
| | | | - Ryuta Nishitai
- Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
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Abdelrahman H, El-Menyar A, Peralta R, Al-Thani H. Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients. World J Gastrointest Surg 2023; 15:757-775. [PMID: 37342859 PMCID: PMC10277941 DOI: 10.4240/wjgs.v15.i5.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/18/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
Background: Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging. Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries. Bowel anastomosis after trauma-related resection is associated with a high rate of leakage. The ability of the surgeon’s bare eye to determine bowel viability remains limited, and the need for a more standardized objective assessment has not yet been fulfilled. Hence, there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize trauma-associated complications. Indocyanine green (ICG) coupled with fluorescence angiography is a potential solution for this problem. ICG is a fluorescent dye that responds to near-infrared irradiation. Methods: We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery. Discussion: ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance. However, there is a paucity of information regarding the use of this technology to treat traumas. Recently, angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions, leading to fewer cases of anastomotic insufficiency. This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety. However, there is no consensus on the ideal dose, time, and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings. Conclusions: There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection. This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients’ operative care and safety in the field of trauma surgery.
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Affiliation(s)
| | - Ayman El-Menyar
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Ruben Peralta
- Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Hassan Al-Thani
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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Gavriilidis P, Edwin B, Pelanis E, Hidalgo E, de'Angelis N, Memeo R, Aldrighetti L, Sutcliffe RP. Navigated liver surgery: State of the art and future perspectives. Hepatobiliary Pancreat Dis Int 2022; 21:226-233. [PMID: 34544668 DOI: 10.1016/j.hbpd.2021.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND In recent years, the development of digital imaging technology has had a significant influence in liver surgery. The ability to obtain a 3-dimensional (3D) visualization of the liver anatomy has provided surgery with virtual reality of simulation 3D computer models, 3D printing models and more recently holograms and augmented reality (when virtual reality knowledge is superimposed onto reality). In addition, the utilization of real-time fluorescent imaging techniques based on indocyanine green (ICG) uptake allows clinicians to precisely delineate the liver anatomy and/or tumors within the parenchyma, applying the knowledge obtained preoperatively through digital imaging. The combination of both has transformed the abstract thinking until now based on 2D imaging into a 3D preoperative conception (virtual reality), enhanced with real-time visualization of the fluorescent liver structures, effectively facilitating intraoperative navigated liver surgery (augmented reality). DATA SOURCES A literature search was performed from inception until January 2021 in MEDLINE (PubMed), Embase, Cochrane library and database for systematic reviews (CDSR), Google Scholar, and National Institute for Health and Clinical Excellence (NICE) databases. RESULTS Fifty-one pertinent articles were retrieved and included. The different types of digital imaging technologies and the real-time navigated liver surgery were estimated and compared. CONCLUSIONS ICG fluorescent imaging techniques can contribute essentially to the real-time definition of liver segments; as a result, precise hepatic resection can be guided by the presence of fluorescence. Furthermore, 3D models can help essentially to further advancing of precision in hepatic surgery by permitting estimation of liver volume and functional liver remnant, delineation of resection lines along the liver segments and evaluation of tumor margins. In liver transplantation and especially in living donor liver transplantation (LDLT), 3D printed models of the donor's liver and models of the recipient's hilar anatomy can contribute further to improving the results. In particular, pediatric LDLT abdominal cavity models can help to manage the largest challenge of this procedure, namely large-for-size syndrome.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, B15 2TH, UK.
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Egidijus Pelanis
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ernest Hidalgo
- Department of Hepato-Pancreatico-Biliary Surgery and Transplantation, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nicola de'Angelis
- Department of Digestive Surgery, University Hospital Henri Mondor (AP-HP), 94010 Créteil and University of Paris Est, Créteil, France
| | - Riccardo Memeo
- Department of Hepatobiliary and Pancreatic Surgery, Miulli Hospital, Acquaviva delle Fonti, Bari 70021, Italy
| | - Luca Aldrighetti
- Division of Hepatobiliary Surgery, San Raffaele Hospital, Via Olgettina 60, Milan 20132, Italy
| | - Robert P Sutcliffe
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, B15 2TH, UK
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Indocyanine Green Fluorescence Navigation in Liver Surgery: A Systematic Review on Dose and Timing of Administration. Ann Surg 2022; 275:1025-1034. [PMID: 35121701 DOI: 10.1097/sla.0000000000005406] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Indocyanine green (ICG) fluorescence has proven to be a high potential navigation tool during liver surgery; however, its optimal usage is still far from being standardized. METHODS A systematic review was conducted on MEDLINE/PubMed for English articles that contained the information of dose and timing of ICG administration until February 2021. Successful rates of tumor detection and liver segmentation, as well as tumor/patient background and imaging settings were also reviewed. The quality assessment of the articles was performed in accordance with the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS Out of initial 311 articles, a total of 72 manuscripts were obtained. The quality assessment of the included studies revealed usually low; only 9 articles got qualified as high quality. Forty articles (55%) focused on open resections, whereas 32 articles (45%) on laparoscopic and robotic liver resections. Thirty-four articles (47%) described tumor detection ability, and 25 articles (35%) did liver segmentation ability, and the others (18%) did both abilities. Negative staining was reported (42%) more than positive staining (32%). For tumor detection, majority used the dose of 0.5 mg/kg within 14 days before the operation day, and an additional administration (0.02-0.5 mg/kg) in case of longer preoperative interval. Tumor detection rate was reported to be 87.4% (range, 43%-100%) with false positive rate reported to be 10.5% (range, 0%-31.3%). For negative staining method, the majority used 2.5 mg/body, ranging from 0.025 to 25 mg/body. For positive staining method, the majority used 0.25 mg/body, ranging from 0.025 to 12.5 mg/body. Successful segmentation rate was 88.0% (range, 53%-100%). CONCLUSION The time point and dose of ICG administration strongly needs to be tailored case by case in daily practice, due to various tumor/patient backgrounds and imaging settings.
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Salehi O, Kazakova V, Vega EA, Conrad C. Indocyanine green staining for intraoperative perfusion assessment. Minerva Surg 2021; 76:220-228. [PMID: 34080819 DOI: 10.23736/s2724-5691.21.08673-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Indocyanine green (ICG) is a fluorescent iodide-based dye which is used in hepatic surgery to evaluate the biliary tree, liver perfusion, and function. While liver perfusion assessment and delineation of anatomic regions has been performed using ultrasound, ischemic demarcation, or indigo carmine/methylene blue staining, ICG staining can overcome limitations associated with these techniques, such as rapid washout, lack of precision, non-demarcation in damaged livers, and lack of intraparenchymal fidelity. ICG can be used to fluoresce target segments/tumors (Positive staining) or counterstain normal liver tissue leaving areas of interest unstained (negative staining). Moreover, ICG enhancement patterns vary for different tumors, such as colorectal liver metastases vs. hepatocellular carcinoma, providing not only help with detection but also assessment of differentiation. In the field of oncology, benefits of ICG include detection of small radiographically occult tumors, distinction between cirrhotic nodules and cancer, identification of necrotic tumors in chemotherapy-damaged livers, and determining margins when intraoperative ultrasound is inadequate. While ICG has important and expanding indications in hepatic surgery, limitations include small depth of penetrance, need for special monitors/equipment, and potential for dye spillage. ICG is well tolerated, has a small learning curve, minimally invasive surgical integration, and options of both portal vein and peripheral vein injection and hence is a safe and versatile method of anatomic liver mapping, tumor visualization, and liver graft perfusion evaluation in oncologic surgery and liver transplantation. Advancements in technique and technology associated with ICG will aid in increasing the indications in hepato-biliary surgery.
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Affiliation(s)
- Omid Salehi
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Vera Kazakova
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA -
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Otsuka Y, Matsumoto Y, Ito Y, Okada R, Maeda T, Ishii J, Kajiwara Y, Okubo K, Funahashi K, Kaneko H. Intraoperative guidance using ICG fluorescence imaging system for safe and precise laparoscopic liver resection. Minerva Surg 2021; 76:211-219. [PMID: 33890439 DOI: 10.23736/s2724-5691.21.08597-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) has been spread as minimally invasive surgery for liver disease. Advances in surgical technique and devices enabled us to perform various procedures of LLR. Indocyanine green (ICG) fluorescence imaging has been suggested as useful tool to identify liver tumors, anatomical territory of liver parenchyma, and cholangiography in open liver surgery. Due to recent development, this technology can be applied in LLR. we describe safe and effective using of the ICG fluorescence imaging during LLR. METHODS From September 2013 to August 2019, 34 patients were performed LLR using a total of 46 procedures by ICG fluorescence imaging system for purposes including identification of anatomic domain of the liver in 12 LLRs, detection of liver tumors in 30 nodules, or intraoperative cholangiography in 4 LLRs. RESULTS During the detection of liver tumors, 25 nodules in 30 malignant to benign tumors were positively detected (83.3%). Although there has been no publication regarding information on ICG fluorescence imaging of low grade malignant or benign tumors, we found positive emission in focal nodular hyperplasia, an angiomyolipoma, and an intraductal papillary neoplasm of the bile duct. The identification of anatomic domain in the liver was successful in all 12 LLRs with negative and positive staining techniques. In the intraoperative cholangiography, all 4 tests were successfully performed. One of 4 patients were found to have biliary leakage which was repaired intraoperatively. CONCLUSIONS The ICG fluorescence imaging could be useful in safe and precise performance of LLR.
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Affiliation(s)
- Yuichiro Otsuka
- Division of General and Gastroenterological Surgery (Omori), Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan -
| | - Yu Matsumoto
- Division of General and Gastroenterological Surgery (Omori), Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yuko Ito
- Division of General and Gastroenterological Surgery (Omori), Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Rei Okada
- Division of General and Gastroenterological Surgery (Omori), Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Tetsuya Maeda
- Division of General and Gastroenterological Surgery (Omori), Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Jun Ishii
- Division of General and Gastroenterological Surgery (Omori), Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yoji Kajiwara
- Division of General and Gastroenterological Surgery (Omori), Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Kazunori Okubo
- Division of General and Gastroenterological Surgery (Omori), Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Kimihiko Funahashi
- Division of General and Gastroenterological Surgery (Omori), Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hironori Kaneko
- Division of General and Gastroenterological Surgery (Omori), Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
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Thammineedi SR, Saksena AR, Nusrath S, Iyer RR, Shukla S, Patnaik SC, Reddy RP, Boleneni N, Sharma RM, Smith L, Are C. Fluorescence-guided cancer surgery-A new paradigm. J Surg Oncol 2021; 123:1679-1698. [PMID: 33765329 DOI: 10.1002/jso.26469] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
Fluorescence-guided surgery is an emerging and promising operative adjunct to assist the surgeon in various aspects of oncosurgery, ranging from assessing perfusion, identification, and characterization of tumors and peritoneal metastases, mapping of lymph nodes/leaks, and assistance for fluorescence-guided surgery (FGS). This study aims to provide an overview of principles, currently available dyes, platforms, and surgical applications and summarizes the available literature on the utility of FGS with a focus on abdomino-thoracic malignancies.
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Affiliation(s)
- Subramanyeshwar Rao Thammineedi
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Ajesh Raj Saksena
- Division of Colorectal Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Syed Nusrath
- Division of Upper GI Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - R Rajagopalan Iyer
- Division of Gynecologic Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Srijan Shukla
- Division of Thoracic Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Sujit Chyau Patnaik
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - R Pratap Reddy
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Naren Boleneni
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Rakesh M Sharma
- Division of Urologic Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Centre, Omaha, Nebraska, USA
| | - Chandrakanth Are
- Department of Surgery, University of Nebraska Medical Centre, Omaha, Nebraska, USA
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Liu Y, Gao B, Fang C, Su S, Yang X, Tian J, Li B. Application of Near-Infrared Fluorescence Imaging Technology in Liver Cancer Surgery. Surg Innov 2021; 29:1553350621997777. [PMID: 33634713 DOI: 10.1177/1553350621997777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background. Hepatocellular carcinoma, among the most common malignant digestive system tumorsworldwide, is most effectively treated with precise surgical resection. Near-infrared fluorescence imaging technology is being increasingly used clinically and has achieved great initial results in the navigation of liver cancer surgery. Methods. This review describes the application of indocyanine green fluorescence (ICG) imaging technology with near-infrared window I in the navigation of liver cancer surgery, explores novel fluorescent probes and near-infrared window II fluorescence imaging technology, and discusses the development status of the 2 emerging tools. Results. ICG fluorescence imaging technology can precisely localize the tumor, reveal the boundary of liver cancer or liver segment, and identify the bile leakage. The novel fluorescent probe is more targeted than ICG, which makes the detection of cancer more accurate. Near-infrared window II fluorescence imaging technology can lead to outstanding gains in deeper detection, higher resolution, and fidelity. But, due to the shortcomings of machine and probe, it is not widely used in clinical. Conclusion. Near-infrared fluorescence imaging has great development potential. With the advent of precision medicine and the progress of various biotechnology studies, fluorescence imaging technology will be better developed and applied in the diagnosis, surgical navigation, and treatment of liver cancer.
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Affiliation(s)
- Ying Liu
- Department of Hepatobiliary Surgery, 556508The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- Academician (expert) Workstation of Sichuan Province, Luzhou, Sichuan Province, China
| | - Benjian Gao
- Department of Hepatobiliary Surgery, 556508The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- Academician (expert) Workstation of Sichuan Province, Luzhou, Sichuan Province, China
| | - Cheng Fang
- Department of Hepatobiliary Surgery, 556508The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- Academician (expert) Workstation of Sichuan Province, Luzhou, Sichuan Province, China
| | - Song Su
- Department of Hepatobiliary Surgery, 556508The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- Academician (expert) Workstation of Sichuan Province, Luzhou, Sichuan Province, China
| | - Xiaoli Yang
- Department of Hepatobiliary Surgery, 556508The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- Academician (expert) Workstation of Sichuan Province, Luzhou, Sichuan Province, China
| | - Jie Tian
- Beijing Key Laboratory of Molecular Imaging, Beijing, China
- 74519University of Chinese Academy of Sciences, Beijing, China
| | - Bo Li
- Department of Hepatobiliary Surgery, 556508The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- Academician (expert) Workstation of Sichuan Province, Luzhou, Sichuan Province, China
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13
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Nishino H, Seo S, Hatano E, Nitta T, Morino K, Toda R, Fukumitsu K, Ishii T, Taura K, Uemoto S. What is a precise anatomic resection of the liver? Proposal of a new evaluation method in the era of fluorescence navigation surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:479-488. [PMID: 32896953 DOI: 10.1002/jhbp.824] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/24/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE Indocyanine green (ICG) fluorescence navigation has been adapted for anatomic liver resection (AR) but an objective method for evaluation of its validity is required. This pilot study aimed to propose a new method to evaluate the accuracy of parenchymal division along the plane between hepatic segments and estimate the real-time navigation efficacy for AR by the Medical Imaging Projection System (MIPS), which continuously demonstrates the transection plane using projection mapping with ICG fluorescence. METHODS Ten patients who underwent open AR using liver segmentation with ICG fluorescence technique between August 2016 and July 2019 were included: six patients under MIPS guidance (MIPS group), while four using only conventional ICG fluorescence technique before parenchymal resection (non-MIPS group). Densitometry of the captured fluorescence image was performed to evaluate the fluorescence area ratio of each transection plane. The accurate fluorescence area ratio was calculated by subtracting the fluorescence area rate on the resected side from that on the remnant side. RESULTS The accurate fluorescence area ratio of the MIPS group and the non-MIPS group was 23.0 ± 12.6% and 5.6 ± 9.5%, respectively (P = .038). CONCLUSIONS Based on the results of our new method, real-time navigation using the MIPS may facilitate performing AR along the plane between hepatic segments.
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Affiliation(s)
- Hiroto Nishino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Nitta
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan
| | - Koshiro Morino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Rei Toda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Fukumitsu
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takamichi Ishii
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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14
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Lwin TM, Hoffman RM, Bouvet M. Fluorescence-guided hepatobiliary surgery with long and short wavelength fluorophores. Hepatobiliary Surg Nutr 2020; 9:615-639. [PMID: 33163512 DOI: 10.21037/hbsn.2019.09.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Fluorescence-guided surgery (FGS) is a potentially powerful tool for hepatobiliary (HPB) surgery. The high sensitivity of fluorescence navigation is especially useful in settings where tactile feedback is limited. Objective The present narrative review evaluates literature on the use of FDA-approved fluorophores such as methylene blue (MB), 5-aminolevulinic acid (5-ALA), and indocyanine green (ICG) for clinical intra-operative image-guidance during HPB surgery. Evidence Review Approaches such as dosing, timing, imaging devices and comparative endpoints are summarized. The feasibility and safety of fluorophores in visualizing the biliary tree, identify biliary leaks, outline anatomic hepatic segments, identify tumors, and evaluate perfusion and graft function in liver transplants are discussed. Findings Tumor-specific probes are a promising advancement in FGS with a greater degree of specificity. The current status of tumor-specific probes being evaluated in clinical trials are summarized. Conclusions and Relevance for Reviews Relevant discussion of promising tumor-specific probes in pre-clinical development are discussed. Fluorescence-guidance in HPB surgery is relatively new, but current literature shows that the dyes are reliably able to outline desired structures with a variety of dosing, timing, and imaging devices to provide real-time intra-operative anatomic information to surgeons. Development of tumor-specific probes will further advance the field of HPB surgery especially during oncologic resections.
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Affiliation(s)
- Thinzar M Lwin
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Robert M Hoffman
- Department of Surgery, University of California San Diego, San Diego, CA, USA.,AntiCancer, Inc., San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - Michael Bouvet
- Department of Surgery, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
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15
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Sakata K, Kijima T, Arai O. Initial Report: A Novel Intraoperative Navigation System for Laparoscopic Liver Resection Using Real-Time Virtual Sonography. Sci Rep 2020; 10:6174. [PMID: 32277107 PMCID: PMC7148355 DOI: 10.1038/s41598-020-63131-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/23/2020] [Indexed: 11/17/2022] Open
Abstract
Recent progress in navigation has revealed problems involving non-rigid registration for hepatic surgery. With the increasing popularity of laparoscopic liver surgery, a new laparoscopic navigation system is necessary. This study involved an in-vitro demonstration of a 3-dimensional printer model and in vivo demonstration in four patients. For the in vitro examination, a position detecting unit attached at 33 cm and 13 cm distance conditions from the tip of the electrocautery was examined eight times at the marked points on the liver surface eight times respectively. The differences between the simulation and the authentic dissecting plane were conventionally investigated in vivo. In vitro, the errors of the 33 cm and 13 cm distance model were7.8 ± 3.5 mm (mean ± SD), and 3.3 ± 1.0 mm, respectively. The mean differences of the dissection plane were within 10 mm. The potentiality and safety of the novel navigation system was confirmed, although further investigation is recommended.
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Affiliation(s)
- Koichiro Sakata
- Japan Seafares Relief Association Ekisaikai Moji Hospital 1-3-1 Kiyotaki Mojiku Kitakyushu, Fukuoka, 801-8505, Japan. .,JCHO Shimonoseki Medical Centre, 3-3-8 kamishinchi-machi, Shimonoseki, Yamaguchi, 083-231-5811, Japan.
| | - Taiki Kijima
- JCHO Shimonoseki Medical Centre, 3-3-8 kamishinchi-machi, Shimonoseki, Yamaguchi, 083-231-5811, Japan
| | - Osamu Arai
- Hitachi, Ltd. Healthcare Business Unit, 3-1-1, Higashikoigakubo, Kokubunji-shi, Tokyo, 185-0014, Japan
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16
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Gon H, Komatsu S, Murakami S, Kido M, Tanaka M, Kuramitsu K, Tsugawa D, Awazu M, Toyama H, Fukumoto T. Real-time navigation during hepatectomy using fusion indocyanine green-fluorescence imaging: protocol for a prospective cohort study. BMJ Open 2019; 9:e030233. [PMID: 31427337 PMCID: PMC6701684 DOI: 10.1136/bmjopen-2019-030233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION In-vivo fluorescence imaging techniques using indocyanine green (ICG) to identify liver tumours and hepatic segment boundaries have been recently developed. The purpose of this study is to evaluate the efficacy of fusion ICG-fluorescence imaging for navigation during hepatectomy. METHODS AND ANALYSIS This will be an exploratory single-arm clinical trial; patients with liver tumours will undergo hepatectomy using the ICG-fluorescence imaging system. In total, 110 patients with liver tumours scheduled for elective hepatectomy will be included in this study. Preoperatively, ICG will be intravenously injected at a dose of 0.5 mg/kg body weight within 2 days. To detect liver tumours intraoperatively, the hepatic surface will be initially observed using the ICG-fluorescence imaging system. After identifying and clamping the portal pedicle corresponding to the hepatic segments, including the liver tumours to be resected, additional ICG will be injected intravenously at a dose of 0.5 mg/kg body weight to identify the boundaries of the hepatic segments. The primary outcome measure will be the success or failure of the ICG-fluorescence imaging system in identifying hepatic segments. The secondary outcomes will be the success or failure in identifying liver tumours, liver function indicators, operative time, blood loss, rate of postoperative complications and recurrence-free survival. The findings obtained through this study are expected to help to establish the utility of ICG-fluorescence imaging systems, and therefore contribute to prognostic outcome improvements in patients undergoing hepatectomy for various causes. ETHICS AND DISSEMINATION The protocol has been approved by the Kobe University Clinical Research Ethical Committee. The findings of this study will be disseminated widely through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER UMIN000031054 and jRCT1051180070.
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Affiliation(s)
- Hidetoshi Gon
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shohei Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sae Murakami
- Clinical and Translational Research Center, Kobe University Hospital, Kobe, Japan
| | - Masahiro Kido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Motofumi Tanaka
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kaori Kuramitsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Tsugawa
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahide Awazu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirochika Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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17
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Nishino H, Hatano E, Seo S, Nitta T, Saito T, Nakamura M, Hattori K, Takatani M, Fuji H, Taura K, Uemoto S. Real-time Navigation for Liver Surgery Using Projection Mapping With Indocyanine Green Fluorescence: Development of the Novel Medical Imaging Projection System. Ann Surg 2019; 267:1134-1140. [PMID: 28181939 DOI: 10.1097/sla.0000000000002172] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the present study was to evaluate the usefulness of a new imaging device, the Medical Imaging Projection System (MIPS), which uses the indocyanine green emission signal and active projection mapping, for liver resection. BACKGROUND During anatomic liver resection, surgeons cannot completely view the intraparenchymal structure. Although a fluorescent imaging technique using indocyanine green has recently been developed for hepatobiliary surgery, limitations in its application for real-time navigation persist. METHODS We conducted a retrospective review of surgical and clinical outcomes for 23 patients who underwent anatomic hepatectomy using the MIPS and 29 patients who underwent the procedure without MIPS guidance, between September 2014 and September 2015. RESULTS Preoperative characteristics were comparable between the 2 groups. No significant between-group differences were identified with regard to surgical and clinical outcomes. The demarcation lines were clearly projected by the MIPS in 21 patients; however, the boundary line was undetectable in 2 patients. CONCLUSIONS We developed the MIPS to address limitations in current intraoperative imaging methods. Our retrospective analysis provides evidence of the feasibility and clinical utility of the MIPS to identify anatomical landmarks for parenchymal dissection. The MIPS holds promise as a novel real-time navigation system for liver resection.
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Affiliation(s)
- Hiroto Nishino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Nitta
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | | | - Kayo Hattori
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Muneo Takatani
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Hiroaki Fuji
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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18
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Concomitant Use of Indocyanine Green Fluorescence Imaging and Interventional Radiology for Detection of Liver Segments During Laparoscopic Anatomical Liver Resection: Pilot Feasibility Study. Surg Laparosc Endosc Percutan Tech 2019; 29:242-246. [DOI: 10.1097/sle.0000000000000631] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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19
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Zygomalas A, Kehagias I. Up-to-date intraoperative computer assisted solutions for liver surgery. World J Gastrointest Surg 2019; 11:1-10. [PMID: 30705734 PMCID: PMC6354070 DOI: 10.4240/wjgs.v11.i1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/12/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023] Open
Abstract
Computer assisted surgical planning allowed for a better selection of patients, evaluation of operative strategy, appropriate volumetric measurements, identification of anatomical risks, definition of tumour resection margins and choice of surgical approach in liver oncologic resections and living donor liver transplantations. Although preoperative computer surgical analysis has been widely used in daily clinical practice, intraoperative computer assisted solutions for risk analysis and navigation in liver surgery are not widely available or still under clinical evaluation. Computer science technology can efficiently assist modern surgeons during complex liver operations, mainly by providing image guidance with individualized 2D images and 3D models of the various anatomical and pathological structures of interest. Intraoperative computer assisted liver surgery is particularly useful in complex parenchyma-sparing hepatectomies, for intraoperative risk analysis and for the effective treatment of colorectal metastases after neoadjuvant therapy or when they are multiple. In laparoscopic liver surgery, intraoperative computer aid is definitively more important as, apart from a restricted field of view, there is also loss of the fine haptic feedback. Intraoperative computer assisted developments face challenges that prevent their application in daily clinical practice. There is a vast variety of studies regarding intraoperative computer assisted liver surgery but there are no clear objective measurements in order to compare them and select the most effective solutions. An overview of up-to-date intraoperative computer assisted solutions for liver surgery will be discussed.
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Affiliation(s)
- Apollon Zygomalas
- Surgical Oncology, OLYMPION General Clinic of Patras, Patras 26442, Greece
| | - Ioannis Kehagias
- Department of Surgery, University Hospital of Patras, Patras 26500, Greece
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20
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Efficacy of Hepatic Segmental Visualization Using Indocyanine Green Photodynamic Eye Imaging. World J Surg 2019; 43:1308-1312. [DOI: 10.1007/s00268-019-04912-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Huang SW, Ou JJ, Wong HP. The use of indocyanine green imaging technique in patient with hepatocellular carcinoma. Transl Gastroenterol Hepatol 2018; 3:95. [PMID: 30603731 DOI: 10.21037/tgh.2018.10.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 10/29/2018] [Indexed: 01/22/2023] Open
Abstract
Near-infrared indocyanine green (ICG) fluorescence application in liver cancer surgery have been reported in the literature since 2008. To date, most reports emphasized not only to the safety, feasibility and reproducibility, but also the potential benefits of its clinical applications in term of demarcating segmentation for an anatomical resection, tumor identification to achieve tumor free resection margin, detection of small unidentifiable subcapsular nodules as well as extrahepatic metastatic lesions, and fluorescence cholangiography. The purpose of this review is to present the fundamental concept of the interpretation of fluorescence enhancement by different timing through intravascular ICG distribution to liver and biliary washout; to describe step-by-step technical aspects of its use in different purposes, and to expose the diagnostic and therapeutic perspectives of this innovative imaging technique in liver cancer surgery.
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Affiliation(s)
- Shih-Wei Huang
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan.,IRCAD/AITS-Asian Institute of TeleSurgery, Show Chwan Health Care System, Changhua, Taiwan
| | - Jing-Jim Ou
- Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Lukang Town, Changhua, Taiwan
| | - Hon Phin Wong
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan.,IRCAD/AITS-Asian Institute of TeleSurgery, Show Chwan Health Care System, Changhua, Taiwan
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22
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The utility of the subcuticular suture in hepatic resection. Contemp Oncol (Pozn) 2018; 22:184-190. [PMID: 30455591 PMCID: PMC6238092 DOI: 10.5114/wo.2018.78940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/09/2018] [Indexed: 12/12/2022] Open
Abstract
Aim of the study Despite recent technical progress and advances in the perioperative management of liver surgery, postoperative surgical site infection (SSI) is still one of the most common complications that extends hospital stays and increases medical expenses following hepatic surgery. Material and methods From 2001 to 2017 a total of 1180 patients who underwent hepatic resection for liver tumours were retrospectively analysed with respect to the predictive factor of superficial incisional SSI, using a propensity score matching by procedure (subcuticular or mattress suture). Results The incidence of superficial and deep incisional SSIs was found to be 7.1% (84/1180). By propensity score matching (PSM), 121 of the 577 subcuticular suture group patients could be matched with 121 of the 603 mattress suture group patients. Multivariate analysis demonstrated wound closure technique as the only independent risk factor that correlated significantly with the occurrence of superficial incisional SSIs (p = 0.038). C-reactive protein (CRP) levels on postoperative day 4 were significantly higher in patients with incisional SSIs than in those without (p < 0.001). Conclusions Wound closure technique with subcuticular continuous spiral suture using absorbable suture should be considered to minimise the incidence of incisional SSIs. Moreover, wounds should be carefully checked when CRP levels are high on postoperative day 4.
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23
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Comparison of Regeneration of Remnant Liver After Hemihepatectomy with or Without the Middle Hepatic Vein. World J Surg 2018; 42:1100-1110. [PMID: 28929234 DOI: 10.1007/s00268-017-4225-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is no consensus about remnant liver regeneration associated with middle hepatic vein (MHV) resecting. METHODS Seventy-five patients who underwent hemihepatectomy were retrospectively analysed with respect to remnant liver regeneration. The liver remnant volume (LRV) and each sectional volume were postoperatively measured with multidetector computed tomography at day 7 and months 1, 2, 5, and 12 after the operation. RESULTS In right hemihepatectomy cases, the regeneration rate of LRV in the MHV preservation group was significantly higher than that of the MHV resection group at months 5 and 12. In particular, the regeneration rate of remnant segment IV peaked at day 7 and was shrunk after 1 month, and was significant higher in the MHV preservation group. In left hemihepatectomy cases, the regeneration rate of LRV at month 12 was significantly higher in the MHV preservation group. The regeneration rate of the remnant anterior section peaked at 1 month and was shrunk. CONCLUSION In this study, the MHV should be preserved or reconstructed whenever possible during hepatic hemihepatectomy. Hepatic regeneration in the MHV perfusion region becomes poor within 7 days to 1 month after surgery (UMIN000023714).
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24
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Li J, Mohamed M, Fischer L, Nashan B. Segment 5 parenchymal sparing in extended left hepatectomy with respect to venous outflow-is it a feasible procedure? Langenbecks Arch Surg 2018; 403:663-670. [PMID: 29956032 DOI: 10.1007/s00423-018-1673-2] [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: 12/27/2017] [Accepted: 04/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Segment 5 (S5) sparing liver resection for cases that require an anatomic left trisectionectomy has not been reported yet. The authors intended to verify the outcome of S5-sparing extended left hepatectomy (ELH) in respect to venous outflow. METHODS All adult patients who underwent S5-sparing ELH between 2012 and 2017 in authors' institute have been enrolled in this study. S5-sparring ELH was defined as resection of S2, S3, S4, and S8 with or without S1. The surgery planning was based on the images from two-dimensional triphasic computed tomography and/or magnetic resonance imaging. A three-dimensional image reconstruction and liver volumetric study were performed retrospectively. RESULTS Out of 177 cases of major hepatic resection, only seven non-hilar cholangiocarcinoma patients underwent ELH during the study period. S5-sparing ELH was performed to five patients, in whom no tumor involvement in S5. The venous outflow of S5 has been maintained intraoperative, and S5 congestion has not been observed in all patients. Tailored management of the S5 venous outflow ensured an increase in functional remnant liver volume by 52.8% (range, 25.6 to 66.9%) by sparing of S5. A negative resection margin was achieved in all patients. One patient had postoperative bile leak requiring reoperation. No posthepatectomy liver failure (PHLF) has been observed. CONCLUSION S5-sparing ELH is technically feasible. Under the tailored management of S5 venous outflow, the functional future liver remnant can be increased. Further studies with larger sample size are needed to evaluate which circumstances the liver segment 5 could be preserved without venous reconstruction during the left extended hepatectomy.
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Affiliation(s)
- Jun Li
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr.52, 20246, Hamburg, Germany.
| | - Moustafa Mohamed
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr.52, 20246, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr.52, 20246, Hamburg, Germany
| | - Björn Nashan
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr.52, 20246, Hamburg, Germany
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25
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van Manen L, Handgraaf HJM, Diana M, Dijkstra J, Ishizawa T, Vahrmeijer AL, Mieog JSD. A practical guide for the use of indocyanine green and methylene blue in fluorescence-guided abdominal surgery. J Surg Oncol 2018; 118:283-300. [PMID: 29938401 PMCID: PMC6175214 DOI: 10.1002/jso.25105] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/21/2018] [Indexed: 12/14/2022]
Abstract
Near-infrared (NIR) fluorescence imaging is gaining clinical acceptance over the last years and has been used for detection of lymph nodes, several tumor types, vital structures and tissue perfusion. This review focuses on NIR fluorescence imaging with indocyanine green and methylene blue for different clinical applications in abdominal surgery with an emphasis on oncology, based on a systematic literature search. Furthermore, practical information on doses, injection times, and intraoperative use are provided.
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Affiliation(s)
- Labrinus van Manen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France.,Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Takeaki Ishizawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Jan Sven David Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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26
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What is the Optimal Timing for Liver Surgery of Resectable Synchronous Liver Metastases from Colorectal Cancer? Am Surg 2017. [DOI: 10.1177/000313481708300124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The optimal timing of the surgical strategy for colorectal cancer (CRC) presenting with resectable synchronous liver metastases remains unclear and controversial. The aim of this study was to compare simultaneous with staged resection, with respect to morbidity, mortality, and prognosis, including recurrence. A total of 107 patients who underwent initial hepatic resection for resectable synchronous liver metastasis from colorectal cancer were retrospectively analyzed. The 5-year disease-free survival rates were 16.4 per cent in the simultaneous group, and 24.0 per cent in the staged group (P = 0.5486). The 5-year overall survival rates were 70.7 per cent in the simultaneous group and 67.9 per cent in the staged group (P = 0.8254). Perioperative chemotherapy did not have a significant effect. Tumor depth of CRC (≥pT4) was the only key factor influencing prognosis. Postoperative intestinal anastomotic leakage occurred in nine patients (8.4%). On multivariate analysis, simultaneous surgery was shown to be the only independent risk factor for the occurrence of postoperative intestinal anastomotic leakage (P = 0.0163). In conclusion, neither timing of hepatic resection (simultaneous or staged) nor perioperative chemotherapy represented significant prognostic factors. The simultaneous surgery was the only independent risk factor for intestinal anastomotic leakage. Therefore, we recommend staged hepatic surgery for synchronous CRC and liver metastasis from colorectal cancer.
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The utility of 5-aminolevulinic acid-mediated photodynamic diagnosis in the detection of intraoperative bile leakage. Am J Surg 2016; 213:1077-1082. [PMID: 27871684 DOI: 10.1016/j.amjsurg.2016.09.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/24/2016] [Accepted: 09/30/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this retrospective study was to evaluate the utility of the new intraoperative bile leakage test as a preventive measure of postoperative bile leakage. METHOD 737 patients were retrospectively analyzed with respect to the management of intra- and post-operative bile leakage. RESULTS Nine (8.3%) of 109 patients evaluated using conventional white light fluorescent imaging were recognized as having intra-operative bile leakage. However, performance of 5-aminolevulinic acid (5-ALA)-mediated PDD detected bile leakage intraoperatively not only in these 9 patients, but also in an additional 6 patients, such that 'red fluorescence' at the cut surface of the liver, was visualized in a total of 15 patients. The postoperative courses of most patients were uneventful, and postoperative bile leakages occurred in only one (0.9%) patient. CONCLUSION 5-ALA fluorescence imaging may be needed to prevent postoperative bile leakage in patients at high risk for this surgical complication after hepatic resection.
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Yamamoto KN, Ishii M, Inoue Y, Hirokawa F, MacArthur BD, Nakamura A, Haeno H, Uchiyama K. Prediction of postoperative liver regeneration from clinical information using a data-led mathematical model. Sci Rep 2016; 6:34214. [PMID: 27694914 PMCID: PMC5046126 DOI: 10.1038/srep34214] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/09/2016] [Indexed: 12/12/2022] Open
Abstract
Although the capacity of the liver to recover its size after resection has enabled extensive liver resection, post-hepatectomy liver failure remains one of the most lethal complications of liver resection. Therefore, it is clinically important to discover reliable predictive factors after resection. In this study, we established a novel mathematical framework which described post-hepatectomy liver regeneration in each patient by incorporating quantitative clinical data. Using the model fitting to the liver volumes in series of computed tomography of 123 patients, we estimated liver regeneration rates. From the estimation, we found patients were divided into two groups: i) patients restored the liver to its original size (Group 1, n = 99); and ii) patients experienced a significant reduction in size (Group 2, n = 24). From discriminant analysis in 103 patients with full clinical variables, the prognosis of patients in terms of liver recovery was successfully predicted in 85-90% of patients. We further validated the accuracy of our model prediction using a validation cohort (prediction = 84-87%, n = 39). Our interdisciplinary approach provides qualitative and quantitative insights into the dynamics of liver regeneration. A key strength is to provide better prediction in patients who had been judged as acceptable for resection by current pragmatic criteria.
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Affiliation(s)
- Kimiyo N. Yamamoto
- Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
- Mathematical Biology Laboratory, Department of Biology, Faculty of Sciences, Kyushu University, Fukuoka, Japan
| | - Masatsugu Ishii
- Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
| | - Yoshihiro Inoue
- Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
| | - Fumitoshi Hirokawa
- Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
| | - Ben D. MacArthur
- Mathematical Sciences, University of Southampton, SO17 1BJ, UK
- Human Development and Health, Faculty of Medicine, University of Southampton, SO17 1BJ, UK
| | - Akira Nakamura
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Hiroshi Haeno
- Mathematical Biology Laboratory, Department of Biology, Faculty of Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhisa Uchiyama
- Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
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Maruyama H, Sekimoto T, Yokosuka O. Role of contrast-enhanced ultrasonography with Sonazoid for hepatocellular carcinoma: evidence from a 10-year experience. J Gastroenterol 2016; 51:421-33. [PMID: 26694825 DOI: 10.1007/s00535-015-1151-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/25/2015] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) represents primary liver cancer. Because the development of HCC limits the prognosis as well as the quality of life of the patients, its management should be properly conducted based on an accurate diagnosis. The liver is the major target organ of ultrasound (US), which is the simple, non-invasive, and real-time imaging method available worldwide. Microbubble-based contrast agents are safe and reliable and have become popular, which has resulted in the improvement of diagnostic performances of US due to the increased detectability of the peripheral blood flow. Sonazoid (GE Healthcare, Waukesha, WI, USA), a second-generation contrast agent, shows the unique property of accumulation in the liver and spleen. Contrast-enhanced US with Sonazoid is now one of the most frequently used modalities in the practical management of liver tumors, including the detection and characterization of the nodule, evaluation of the effects of non-surgical treatment, intraoperative support, and post-treatment surveillance. This article reviews the 10-year evidence for contrast-enhanced US with Sonazoid in the practical management of HCC.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670, Japan.
| | - Tadashi Sekimoto
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670, Japan
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670, Japan
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Azagury DE, Dua MM, Barrese JC, Henderson JM, Buchs NC, Ris F, Cloyd JM, Martinie JB, Razzaque S, Nicolau S, Soler L, Marescaux J, Visser BC. Image-guided surgery. Curr Probl Surg 2015; 52:476-520. [PMID: 26683419 DOI: 10.1067/j.cpsurg.2015.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Dan E Azagury
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Monica M Dua
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - James C Barrese
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Jaimie M Henderson
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Nicolas C Buchs
- Department of Surgery, University Hospital of Geneva, Clinic for Visceral and Transplantation Surgery, Geneva, Switzerland
| | - Frederic Ris
- Department of Surgery, University Hospital of Geneva, Clinic for Visceral and Transplantation Surgery, Geneva, Switzerland
| | - Jordan M Cloyd
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - John B Martinie
- Department of Surgery, Carolinas Healthcare System, Charlotte, NC
| | - Sharif Razzaque
- Department of Surgery, Carolinas Healthcare System, Charlotte, NC
| | - Stéphane Nicolau
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Luc Soler
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Jacques Marescaux
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Brendan C Visser
- Department of Surgery, Stanford University School of Medicine, Stanford, CA.
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Sakoda M, Ueno S, Iino S, Hiwatashi K, Minami K, Kawasaki Y, Kurahara H, Mataki Y, Maemura K, Uenosono Y, Shinchi H, Natsugoe S. Anatomical laparoscopic hepatectomy for hepatocellular carcinoma using indocyanine green fluorescence imaging. J Laparoendosc Adv Surg Tech A 2015; 24:878-82. [PMID: 25347551 DOI: 10.1089/lap.2014.0243] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE It is important to minimize surgical invasiveness in the therapy of patients with hepatocellular carcinoma (HCC), and consequently laparoscopic hepatic resection is widely performed. However, most anatomical resections, except left lateral sectionectomy, remain difficult technically, and laparoscopy-assisted procedures have been introduced as an alternative approach because of the safety and curative success of the operation. We reported previously pure laparoscopic subsegmentectomy of the liver using puncture of the portal branch under percutaneous ultrasound (US) with artificial ascites. Herein, we describe pure anatomical laparoscopic segmentectomy using the puncture method with indocyanine green (ICG) injection under laparoscopic US. PATIENTS AND METHODS Pure laparoscopic segmentectomy was planned for 2 patients with HCC of the liver. Identification of the segment was performed by ICG injection for optical imaging using near-infrared fluorescence under laparoscopic US guidance. RESULTS The procedures were completed successfully, and the postoperative courses were uneventful. CONCLUSIONS Pure laparoscopic segmentectomy for HCC with a conventional puncture technique by ICG injection under laparoscopic US is considered to be a useful procedure featuring both low invasiveness and curative success.
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Affiliation(s)
- Masahiko Sakoda
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine , Kagoshima, Japan
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Inoue Y, Tanaka R, Komeda K, Hirokawa F, Hayashi M, Uchiyama K. Fluorescence detection of malignant liver tumors using 5-aminolevulinic acid-mediated photodynamic diagnosis: principles, technique, and clinical experience. World J Surg 2015; 38:1786-94. [PMID: 24493071 DOI: 10.1007/s00268-014-2463-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Photoactive drugs selectively accumulate in malignant tissue specimens and cause drug-induced fluorescence. Photodynamic diagnosis (PDD) and fluorescence can distinguish normal from malignant tissue. OBJECTIVE METHODS From May 2012 to September 2013, a total of 70 patients underwent hepatic resections using 5-ALA-mediated PDD for liver tumors at our hospital. RESULTS 5-ALA fluorescence was detected in all hepatocellular carcinoma cases with serosa invasion. In liver metastasis from colorectal cancer cases with serosa invasion, 18 patients (85.7 %) were detected, and three patients (14.2 %) whose tumors showed complete response to neoadjuvant chemotherapy showed no fluorescence. Both superficial and deep malignant liver tumors were detected with 92.5 % sensitivity. Using 5-ALA-mediated PDD, tumors remaining at the cut surface and postoperative bile leakage were less frequent than in our previous hepatic resections using conventional white-light observation. Moreover, all malignant liver tumors were completely removed with a clear microscopic margin using 5-ALA, with a significant difference in resection margin width between 5-ALA-mediated PDD (6.7 ± 6.9 mm) and white-light observation (9.2 ± 7.0 mm; p = 0.0083). CONCLUSIONS With the detection of malignant liver tumors, residual tumor and bile leakage at the cut surface of the remnant liver were improved by PDD with 5-ALA. This procedure may provide greater sensitivity than the conventional procedure. Furthermore, 5-ALA-mediated PDD can ensure histological clearance regardless of the resection margin and preserve as much liver parenchyma as possible in patients with impaired liver function.
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Affiliation(s)
- Yoshihiro Inoue
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 daigaku-machi, Takatsuki, Osaka, 569-8686, Japan,
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Shimada S, Ohtsubo S, Ogasawara K, Kusano M. Macro- and microscopic findings of ICG fluorescence in liver tumors. World J Surg Oncol 2015; 13:198. [PMID: 26055754 PMCID: PMC4461923 DOI: 10.1186/s12957-015-0615-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/28/2015] [Indexed: 02/07/2023] Open
Abstract
Background Reports detailing microscopic observations of indocyanine green (ICG) fluorescence imaging (IFI) in hepatocellular carcinoma (HCC) and metastatic liver cancer are rare. We were able to perform macro- and microscopic IFI results in postoperative paraffin-embedded tissue samples and formalin-fixed specimens from liver tumors. Methods Between April 2010 and March 2014, 19 patients with HCC or liver metastases of colorectal tumors underwent liver resection. ICG solution was injected into the peripheral vein from 14 to 2 days prior to operation. We observed liver tumor IFI during the laparotomy and IFI in resected liver sections using a photo dynamic emission (PDE) camera. The IFI of paraffin-embedded tissue samples was observed using a charge-coupled device (CCD) camera. Moreover, we microscopically performed tissue section IFI using a fluorescence microscope with an ICG-B-NQF. Results We performed that IFI characteristics depended on tumor type macroscopically and microscopically. In normal liver tissue, fluorescence consistent with the bile canaliculus was observed. HCC had heterogeneous IFI, forming a total or partial tumor and rim pattern. In metastatic carcinoma, we performed that non-tumor cells in the marginal region showed fluorescence and tumor cells in the central region did not fluoresce. Conclusions We confirmed that the variations of ICG fluorescence imaging patterns reflect different tumor characteristics in not only macroscopic imaging as previous reports but also microscopic imaging. Moreover, the ICG fluorescence method is useful for postoperative pathological detection of microscopic lesions in histopathological specimens. ICG fluorescence in paraffin-embedded tissue samples and formalin-fixed specimens is preserved in the long term.
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Affiliation(s)
- Shingo Shimada
- Department of Surgery, Japan Labor Health and Welfare Organization, Kushiro Rosai Hospital, 13-12, Nakazono-cho, Kushiro, Hokkaido, 085-8533, Japan.
| | - Seiji Ohtsubo
- Department of Oral and Maxillofacial Surgery, Japan Labor Health and Welfare Organization, Kushiro Rosai Hospital, 13-12, Nakazono-cho, Kushiro, Hokkaido, 085-8533, Japan.
| | - Kazuhiro Ogasawara
- Department of Surgery, Japan Labor Health and Welfare Organization, Kushiro Rosai Hospital, 13-12, Nakazono-cho, Kushiro, Hokkaido, 085-8533, Japan.
| | - Mitsuo Kusano
- Department of Surgery, Seiwa Memorial Hospital, 1-5-1-1, Kotoni, Nishi-ku, Sapporo, Hokkaido, 063-0811, Japan.
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Indocyanine Green Fluorescent Imaging for Hepatic Resection of the Right Hepatic Vein Drainage Area. J Am Coll Surg 2015. [PMID: 26195251 DOI: 10.1016/j.jamcollsurg.2015.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Marano A, Priora F, Lenti LM, Ravazzoni F, Quarati R, Spinoglio G. Application of fluorescence in robotic general surgery: review of the literature and state of the art. World J Surg 2015; 37:2800-11. [PMID: 23645129 DOI: 10.1007/s00268-013-2066-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The initial use of the indocyanine green fluorescence imaging system was for sentinel lymph node biopsy in patients with breast or colorectal cancer. Since then, application of this method has received wide acceptance in various fields of surgical oncology, and it has become a valid diagnostic tool for guiding cancer treatment. It has also been employed in numerous conventional surgical procedures with much success and benefit to the patient. The advent of minimally invasive surgery brought with it a new use for fluorescence in helping to improve the safety of these procedures, particularly for single-site procedures. In 2010, a near-infrared camera was integrated into the da Vinci Si System, creating a combination of technical and minimally invasive advantages that have been embraced by several experienced surgeons. The use of fluorescence, although useful, is considered challenging. Only a few studies are currently available on the use of fluorescence in robotic general surgery, whereas many articles have focused on its application in open and laparoscopic surgery. Many of these reports describe promising and satisfactory results, although with some shortcomings. The purpose of this article is to review the current status of the use of fluorescence in general surgery and particularly its role in robotic surgery. We also review potential uses in the future.
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Affiliation(s)
- Alessandra Marano
- Department of General and Oncologic Surgery, SS Antonio e Biagio Hospital, Via Venezia 16, 15121, Alessandria, Italy,
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Abo T, Nanashima A, Tobinaga S, Hidaka S, Taura N, Takagi K, Arai J, Miyaaki H, Shibata H, Nagayasu T. Usefulness of intraoperative diagnosis of hepatic tumors located at the liver surface and hepatic segmental visualization using indocyanine green-photodynamic eye imaging. Eur J Surg Oncol 2014; 41:257-64. [PMID: 25447030 DOI: 10.1016/j.ejso.2014.09.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To improve the diagnostic accuracy for hepatic tumors on the liver surface, we investigated the usefulness of an indocyanine green-photodynamic eye (ICG-PDE) system by comparison with Sonazoid intraoperative ultrasonography (IOUS) in 117 patients. Hepatic segmentation by ICG-PDE was also evaluated. METHODS ICG was administered preoperatively for functional testing and images of the tumor were observed during hepatectomy using a PDE camera. ICG was injected into portal veins to determine hepatic segmentation. RESULTS Accurate diagnosis of liver tumors was achieved with ICG-PDE in 75% of patients, lower than with IOUS (94%). False-positive and false-negative diagnosis rates for ICG-PDE were 24% and 9%, respectively. New small HCCs were detected in 3 patients. The ICG fluorescent pattern in tumors was strong staining in 41%, weak staining in 13%, rim staining in 20% and no staining in 26%. Hepatocellular carcinoma predominantly showed strong staining (61%), while rim staining predominated in cholangiocellular carcinoma (60%) and liver metastasis (55%). Hepatic segmental staining was performed in 28 patients, proving successful in 89%. CONCLUSION ICG-PDE is a useful tool for detecting the precise tumor location at the liver surface, identifying new small tumors, and determining liver segmentation for liver resection.
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Affiliation(s)
- T Abo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - A Nanashima
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - S Tobinaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - S Hidaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - N Taura
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - K Takagi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - J Arai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - H Miyaaki
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - H Shibata
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - T Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
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Chi C, Du Y, Ye J, Kou D, Qiu J, Wang J, Tian J, Chen X. Intraoperative imaging-guided cancer surgery: from current fluorescence molecular imaging methods to future multi-modality imaging technology. Theranostics 2014; 4:1072-84. [PMID: 25250092 PMCID: PMC4165775 DOI: 10.7150/thno.9899] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/31/2014] [Indexed: 12/20/2022] Open
Abstract
Cancer is a major threat to human health. Diagnosis and treatment using precision medicine is expected to be an effective method for preventing the initiation and progression of cancer. Although anatomical and functional imaging techniques such as radiography, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have played an important role for accurate preoperative diagnostics, for the most part these techniques cannot be applied intraoperatively. Optical molecular imaging is a promising technique that provides a high degree of sensitivity and specificity in tumor margin detection. Furthermore, existing clinical applications have proven that optical molecular imaging is a powerful intraoperative tool for guiding surgeons performing precision procedures, thus enabling radical resection and improved survival rates. However, detection depth limitation exists in optical molecular imaging methods and further breakthroughs from optical to multi-modality intraoperative imaging methods are needed to develop more extensive and comprehensive intraoperative applications. Here, we review the current intraoperative optical molecular imaging technologies, focusing on contrast agents and surgical navigation systems, and then discuss the future prospects of multi-modality imaging technology for intraoperative imaging-guided cancer surgery.
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Beppu T, Nitta H, Tsukamoto M, Imai K, Hayashi H, Okabe H, Hashimoto D, Chikamoto A, Ishiko T, Baba H. Percutaneous radiofrequency ablation-assisted laparoscopic hepatectomy. Asian J Endosc Surg 2014; 7:188-92. [PMID: 24754887 DOI: 10.1111/ases.12088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/09/2013] [Accepted: 12/15/2013] [Indexed: 12/07/2022]
Abstract
Metachronous rectal liver metastasis (15 mm in segment 8 ventral) was managed with laparoscopic hepatectomy using segmental blood flow occlusion with radiofrequency ablation. During liver dissection, the ischemic area was visible as a distinct hypoechoic area on intraoperative enhanced ultrasound; with a photodynamic eye camera, it appeared as a discolored lesion. The resection was completed with adequate margins.
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Affiliation(s)
- Toru Beppu
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan; Department of Multidisciplinary Treatment for Gastroenterological Cancer, Innovation Center for Translational Research, Kumamoto University Hospital, Kumamoto, Japan
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Mitani Y, Kubota A, Ueno M, Takifuji K, Watanabe T, Hayami S, Kounami S, Tsujimoto H, Yamaue H. Real-time identification of hepatoblastoma using a near infrared imaging with indocyanine green. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Verbeek FPR, van der Vorst JR, Schaafsma BE, Hutteman M, Bonsing BA, van Leeuwen FWB, Frangioni JV, van de Velde CJH, Swijnenburg RJ, Vahrmeijer AL. Image-guided hepatopancreatobiliary surgery using near-infrared fluorescent light. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 19:626-37. [PMID: 22790312 PMCID: PMC3501168 DOI: 10.1007/s00534-012-0534-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Improved imaging methods and surgical techniques have created a new era in hepatopancreatobiliary (HPB) surgery. Despite these developments, visual inspection, palpation, and intraoperative ultrasound remain the most utilized tools during surgery today. This is problematic, though, especially in laparoscopic HPB surgery, where palpation is not possible. Optical imaging using near-infrared (NIR) fluorescence can be used for the real-time assessment of both anatomy (e.g., sensitive detection and demarcation of tumours and vital structures) and function (e.g., assessment of luminal flow and tissue perfusion) during both open and minimally invasive surgeries. Methods This article reviews the published literature related to preclinical development and clinical applications of NIR fluorescence imaging during HPB surgery. Results NIR fluorescence imaging combines the use of otherwise invisible NIR fluorescent contrast agents and specially designed camera systems, which are capable of detecting these contrast agents during surgery. Unlike visible light, NIR fluorescent light can penetrate several millimetres through blood and living tissue, thus providing improved detectability. Applications of this technique during HPB surgery include tumour imaging in liver and pancreas, and real-time imaging of the biliary tree. Conclusions NIR fluorescence imaging is a promising new technique that may someday improve surgical accuracy and lower complications.
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Affiliation(s)
- Floris P R Verbeek
- Department of Surgery, University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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Abstract
Although the modern surgical era is highlighted by multiple technological advances and innovations, one area that has remained constant is the dependence of the surgeon's vision on white-light reflectance. This renders different body tissues in a limited palette of various shades of pink and red, thereby limiting the visual contrast available to the operating surgeon. Healthy tissue, anatomic variations, and diseased states are seen as slight discolorations relative to each other and differences are inherently limited in dynamic range. In the upcoming years, surgery will undergo a paradigm shift with the use of targeted fluorescence imaging probes aimed at augmenting the surgical armamentarium by expanding the "visible" spectrum available to surgeons. Such fluorescent "smart probes" will provide real-time, intraoperative, pseudo-color, high-contrast delineation of both normal and pathologic tissues. Fluorescent surgical molecular guidance promises another major leap forward to improve patient safety and clinical outcomes, and to reduce overall healthcare costs. This review provides an overview of current and future surgical applications of fluorescence imaging in diseased and nondiseased tissues and focus on the innovative fields of image processing and instrumentation.
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Affiliation(s)
- Ryan K Orosco
- Division of Head and Neck Surgery, University of California San Diego, La Jolla, CA 92093-0647, USA
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Shindoh J, Seyama Y, Umekita N. Three-dimensional staining of liver segments with an ultrasound contrast agent as an aid to anatomic liver resection. J Am Coll Surg 2012; 215:e5-10. [PMID: 22683072 DOI: 10.1016/j.jamcollsurg.2012.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 05/16/2012] [Accepted: 05/16/2012] [Indexed: 12/16/2022]
Affiliation(s)
- Junichi Shindoh
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
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