Intraoperative fluorescent imaging using indocyanine green for liver mapping and cholangiography

Abstract

Background Preoperative imaging is widely used and extremely helpful in hepatobiliary surgery. However, transfer of preoperative data to a intraoperative situation is very difficult. Surgeons need intraoperative anatomical information using imaging data for safe and precise operation in the field of hepatobiliary surgery. We have developed a new system for mapping liver segments and cholangiograms using intraoperative indocyanine green (ICG) fluorescence under infrared light observation. Method The imaging technique for mapping liver segments and cholangiogram based on ICG fluorescence used an infrared-based navigation system. Eighty one patients with liver tumors underwent hepatectomy from 2006, January to 2009, March. In liver surgery, 1 ml of ICG was injected via the portal vein under observation by the fluorescent imaging system. Fourteen patients were underwent laparoscopic cholecystectomy for chronic cholecystitis with gallstones. In laparoscopic cholecystectomy, 5 ml of ICG was administered intravenously just before operation and the bile duct was observed using the infrared-based navigation system. Result This new technique successfully identified stained subsegments and segments of the liver in 73 of 81 patients (90.1%). Moreover, clear mapping of liver segments was obtained even against a background of liver cirrhosis. Fluorescent cholangiography clearly showed the common bile duct and cystic duct in 10 of 14 patients (71.4%). No adverse reactions to the ICG were encountered. Conclusion Application of this technique allows intraoperative identification of anatomical landmark in hepatobiliary surgery.

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

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

Exclusion criteria for assuring safety of single-incision laparoscopic cholecystectomy

“…If further advancements in surgical techniques, such as robotic surgery (24) and intraoperative fluorescence cholangiography (17)(18)(19)(20)25), enhance safety of SILC, the role of SILC in the treatment of cholecystolithiasis/cholecystitis may gain more presence in future.…”

“…The procedure was performed through Semi-cross method, holding an articulating instrument (Roticulator Endo Grasp; Covidien) with the left hand and a straight instrument with the right hand (15). The triangle of Calot was dissected to reach "critical view of safety" (16), while using fluorescence cholangiography (17)(18)(19)(20) with preoperative and intravenous injection of ICG at any time during the procedures ( Figure 1 and supplementary video 1, http://biosciencetrends. com/docindex.php?year=2015&kanno=6).…”

Enriching the Interventional Vision of Cancer with Fluorescence and Optoacoustic Imaging

“…Fluorescent dyes can reveal vascularization and physiologic parameters such as perfusion or vascular leakage or can track lymphatics at depths of up to 2-3 cm, presenting an alternative to nuclear imaging methods. For this reason, several surgical procedures have considered the use of fluorescence guidance, such as to gain tissue characterization contrast in hepatobiliary and pancreatic surgery (14) and to detect lymph nodes (15,16). However, fluorescent dyes have not been shown ideal for cancer detection, mostly because of a lack of specificity.…”