Applications of intraoperative fluorescence imaging to hepatobiliary and pancreatic surgery (Conference Presentation)

Abstract

Recently, in vivo fluorescence imaging using indocyanine green (ICG) has actively been applied to hepatobiliary and pancreatic surgery in clinical settings. 1) Fluorescence cholangiography: fluorescence images of the extrahepatic bile ducts can be obtained by intrabiliary injection of ICG solution (0.025 mg/mL) or preoperative intravenous injection of ICG (2.5 mg). The latter technique begins to be used worldwide for confirmation of the bile duct anatomy during minimally-invasive cholecystectomy. 2) Identification of hepatic tumors: Following preoperative intravenous injection of ICG (0.5 mg/kg), it can accumulate in hepatocellular carcinoma tissues and in non-cancerous hepatic parenchyma surrounding liver metastasis, enabling intraoperative identification of subcapsular hepatic tumors by fluorescence imaging. 3) Hepatic segmentation: ICG solution (0.25 mg/5 mL) is injected into a tumor-bearing portal branch under ultrasound guidance (positive staining). ICG can also be administered intravenously following closure of a corresponding portal pedicle (negative staining). These techniques enables delineation of hepatic segmental boundaries throughout surgical procedures. 4) Assessment of blood perfusion: Fluorescence imaging following intraoperative bolus injection of ICG (2.5mg) visualizes arterial/portal blood flows and perfusion in the surrounding organs during surgeries requiring resection/reconstruction of the major vessels. for intraoperative visualization of biological structures and perfusion assessment. In addition, we have developed a novel fluorophore (glutaryl-phenylalanine hydroxymethyl rhodamine green) activated by pancreatic chymotrypsin for real-time identification of pancreatic juice leakage.