Indocyanine-coated fluorescent clips for localization of gastrointestinal tumors

Abstract

Background:The innovative use of the fluorescent dye indocyanine green (ICG) represents a significant advancement in surgical oncology. This study aimed to assess the feasibility of ICG-coated clips for enhancing tumor localization during minimally invasive gastrointestinal surgery. Materials and Methods: This study was conducted using female Yucatan miniature pigs, which approximate the human anatomy. Two pigs, each weighing 25-30 kg, underwent simulated gastrointestinal surgery. The ICG-coated clips used were VITTZ clips, which were not yet approved by the Korea Food and Drug Administration but utilized for research purposes. The visibility of the clips was evaluated using Stryker 1588 and 1688 Advanced Imaging Modalities platforms with SPY fluorescence technology. The procedure involved the endoscopic placement of clips in the stomach and colon, followed by laparoscopic visualization using ICG imaging systems. Result:The ICG-coated clips demonstrated superior visibility in both the stomach and colon. In the stomach, the Endoscopic Near-Infrared Visualization (ENV) mode revealed four bright spots on the gastric wall, with two distinctly visible in the overlay mode. Three bright fluorescent lights were discernible in the sigmoid colon using both imaging modes. The fluorescence intensity was slightly clearer in the ENV mode than in the overlay mode. Conclusion: ICG-coated clips can improve tumor localization, which is important during minimally invasive gastrointestinal surgery. This innovative approach may provide safer and more accurate alternatives.