Background: Dye-enhanced laser ablation (DLA) using a low-power diode laser for indocyanine green (ICG)-stained tissue has proven its effectiveness in dye-enhanced laser photocoagulation of retinal vessels or endoscopic surgical mucosectomy. We have applied DLA in hepatectomy and described its histological distinction in comparison with the cavitron ultrasonic surgical aspirator (CUSA). Methods: A diode laser (UDL-60 Laser unit, Olympus, Tokyo, Japan) with 810 ± 20 nm wavelength was employed for this study. The ICG dye (Diagnogreen^®, Daiichi Pharmaceutical, Tokyo, Japan) with a peak absorption wavelength at 800–810 nm was injected topically into the resection plane of the liver. The liver tissue was divided by touching the tip of the diode laser. Three different concentrations of ICG solution such as 2.0, 1.0 and 0.5 mg/ml were tested in the preliminary animal experiment. The use of a low-power diode laser at 10 W with an ICG concentration of 0.5 mg/ml was the appropriate combination for liver resection. In the clinical series, 27 hepatectomies were performed by DLA, and 10 with CUSA. Results: DLA demonstrated smooth cutting and good hemostasis in liver resection. Among the hepatectomy cases given DLA, no postoperative hemorrhage or bile leakage was noted. The postoperative hospital stay was significantly shorter in the DLA than the CUSA group. The cut surface of the liver was sealed microscopically with a layer of protein coagulum. Conclusions: A layer of protein sealant on the cut surface of the liver contributes to the short postoperative hospital stay when using DLA.

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The safety and efficacy of endovascular coil embolization of intracranial aneurysms is widely accepted. However, recurrence of aneurysms in large cases after coil embolization is a serious problem which remains to be solved. A major cause of recurrence is incomplete organization within the aneurysm. We have been developing modified coils. We read these two papers, and we found the statin reduces aneurymal size. (Am J Cardiol. 1996;97:279–280. Eur J Vasc Endovasc Surg. 2006;32:21–26.) If oral administration of a statin reduces aneurysm growth, could coils coated with a statin be more effective? This discovery was what motivated us to conduct this study. We ligated the distal External carotid artery and made an experimental aneurysm. We then inserted a coil coated with a statin to be reexamined after two and four weeks. We removed at 2 and 4 weeks after coils were implanted. In the case of implanted simvastatin coils, thick tissue had formed at the end of the coils and acted as a plug to inhibit blood flowing into the space of an aneurysm. On the other hand, in the case of the unmodified coil, blood had flowed into the space where the coil was lodged. We analyzed histochemical staining. We found endothelialization at the orifice of an experimental aneurysm, and we saw that there was proliferation of smooth muscle cells within the aneurysm. The percent of organized area of the simvastatin group was significantly higher than the unmodified coil group. We tested another 6 statins in the same way. Two weeks after coil implantation, the experimental aneurysm was cut vertically. The Aneurysmal cavity was fully filled with cellular tissue in the almost cases. In the arterial bifurcation, hemodynamic stress causes wall shear stress, endothelial dysfunction, imbalance of NO, and vascular inflammation. Vascular inflammation causes the infiltration of macrophage, increase of MMP, and destruction of ECM, Or migration of SMC. What are the effect of a statin? We suggest 4 points. First improving endothelial function, second decreasing oxidative stress, third decreasing the vascular inflammation. And fourth statin suppresses the excretion of MMP and inhibits the destruction of ECM. Coils coated with simvastatin effectively accelerated intra-aneurysmal organization and endothelialization over the coils at the orifice to ECA sacs in a rat aneurysm model. Simvastatin is widely used to lower cholesterol, so its safety is already established. We are now preparing drug-eluting coils to optimize the local concentration of simvastatin and its duration of efficacy.DisclosuresT. Kodama: None.