Abstract
Laparoscopic surgery is now a standard treatment for gastric cancer. Currently, the location of the gastric cancer is identified during laparoscopic surgery via the preoperative endoscopic injection of charcoal ink around the primary tumor; however, the wide spread of injected charcoal ink can make it difficult to accurately visualize the specific site of the tumor. To precisely identify the locations of gastric tumors, we developed a fluorescent detection system comprising clips with glass phosphor (Yb3+, Nd3+ doped to Bi2O3-B2O3-based glasses, size: 2 mm × 1 mm × 3 mm) fixed in the stomach and a laparoscopic fluorescent detection system for clip-derived near-infrared (NIR) light (976 nm). We conducted two ex vivo experiments to evaluate the performance of this fluorescent detection system in an extirpated pig stomach and a freshly resected human stomach and were able to successfully detect NIR fluorescence emitted from the clip in the stomach through the stomach wall by the irradiation of excitation light (λ: 808 nm). These results suggest that the proposed combined NIR light-emitting clip and laparoscopic fluorescent detection system could be very useful in clinical practice for accurately identifying the location of a primary gastric tumor during laparoscopic surgery.
Highlights
Gastric cancer is a major cause of disease-related death worldwide, causing the deaths of 723,000 people in 2012 [1], and it is the most common type of cancer in East Asia [2]
We focused on the near-infrared (NIR) wavelength around the 1000 nm band, which has good biological transmission activity [8], and developed a new fluorescent chip with glass phosphor and a laparoscopic fluorescent detection system to assist in the performance of safe and accurate laparoscopic removal of gastric cancer
To detect the NIR light emitted from the fluorescent chip, we developed a laparoscopic fluorescent detection system composed of a medical rigid scope (WA53000A, Olympus Medical Systems Corp., Tokyo, Japan), two notch filters, and a NIR CCD camera with a CCTV lens and camera controller
Summary
Gastric cancer is a major cause of disease-related death worldwide, causing the deaths of 723,000 people in 2012 [1], and it is the most common type of cancer in East Asia [2]. It is sometimes difficult to visualize the exact location of the primary tumor during the laparoscopic operation, as the injected charcoal ink diffusely spreads to areas distant from the tumor in the stomach, unlike in tumors of the colon This charcoal ink diffusion may result in resection with a broad margin containing wide tumor-free tissue, which results in great inconvenience for the patient. To overcome this problem, we developed a new convenient method with which to visualize the exact location of a primary gastric tumor from outside the stomach. Two ex vivo experiments performed in this pilot study demonstrated the successful use of this new detection system
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