Image‐guided hepatopancreatobiliary surgery using near‐infrared fluorescent light

Floris P R Verbeek,Alexander L Vahrmeijer,Fijs W B Van Leeuwen,Boudewijn E Schaafsma,Joost R Van Der Vorst,Rutger‐Jan Swijnenburg,Bert A Bonsing,Cornelis J H Van De Velde,Merlijn Hutteman,John V Frangioni

doi:10.1007/s00534-012-0534-6

Abstract

BackgroundImproved imaging methods and surgical techniques have created a new era in hepatopancreatobiliary (HPB) surgery. Despite these developments, visual inspection, palpation, and intraoperative ultrasound remain the most utilized tools during surgery today. This is problematic, though, especially in laparoscopic HPB surgery, where palpation is not possible. Optical imaging using near-infrared (NIR) fluorescence can be used for the real-time assessment of both anatomy (e.g., sensitive detection and demarcation of tumours and vital structures) and function (e.g., assessment of luminal flow and tissue perfusion) during both open and minimally invasive surgeries.MethodsThis article reviews the published literature related to preclinical development and clinical applications of NIR fluorescence imaging during HPB surgery.ResultsNIR fluorescence imaging combines the use of otherwise invisible NIR fluorescent contrast agents and specially designed camera systems, which are capable of detecting these contrast agents during surgery. Unlike visible light, NIR fluorescent light can penetrate several millimetres through blood and living tissue, thus providing improved detectability. Applications of this technique during HPB surgery include tumour imaging in liver and pancreas, and real-time imaging of the biliary tree.ConclusionsNIR fluorescence imaging is a promising new technique that may someday improve surgical accuracy and lower complications.

Highlights

Over the last few decades, imaging technologies such as ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) have become indispensable tools for preoperative planning in hepatopancreatobiliary (HPB) surgical procedures [1]
Optical imaging using near-infrared (NIR) fluorescence can be used for the realtime assessment of both anatomy and function during both open and minimally invasive surgeries
This review describes the development, current applications, and future prospects of NIR fluorescence imaging for HPB surgery

Summary

Methods

This article reviews the published literature related to preclinical development and clinical applications of NIR fluorescence imaging during HPB surgery. Results NIR fluorescence imaging combines the use of otherwise invisible NIR fluorescent contrast agents and specially designed camera systems, which are capable of. B. van Leeuwen Department of Radiology, University Medical Center, Leiden, The Netherlands. Frangioni Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA. Frangioni Department of Radiology, Beth Israel Deaconess Medical Center, Boston, USA detecting these contrast agents during surgery. NIR fluorescent light can penetrate several millimetres through blood and living tissue, providing improved detectability. Applications of this technique during HPB surgery include tumour imaging in liver and pancreas, and real-time imaging of the biliary tree. Conclusions NIR fluorescence imaging is a promising new technique that may someday improve surgical accuracy and lower complications

Introduction

Findings

Discussion and future prospects