Application of Fluorescence Imaging to Hepatopancreatobiliary Surgery

Abstract

Over the last century, improved imaging methods and surgical techniques have modernized hepatopancreatobiliary (HPB) surgery. However, visual inspection, palpation and intraoperative ultrasound are the primary methods of determining what structures need to be resected during surgery. Using these methods, accurate identification of structures can be challenging, especially in laparoscopic HPB surgery, where palpation is not possible. This can result in irradical resections and iatrogenic damage to vital structures. Intraoperative imaging using near-infrared (NIR) fluorescence can be used for real-time assessment of both anatomy and function. In this chapter, the current status of (clinical) applications of NIR fluorescence imaging using indocyanine green during HPB surgery is evaluated. NIR fluorescence imaging combines the use of NIR fluorescent contrast agents and specially designed imaging systems which are capable of detecting these contrast agents during surgery. In comparison with visible light, NIR fluorescent light can penetrate living tissue several millimeters deeper, providing improved detectability. In HPB surgery, intraoperative NIR fluorescence has been evaluated for tumor imaging in the liver and pancreas, and real-time imaging of the biliary tree. In these applications, NIR fluorescence imaging has been shown to be a promising new technique that may improve surgical accuracy and lower complications in the future.