Indocyanine Green Near-infrared Fluorescence Research Articles

A Novel Parameter Identified Using Indocyanine Green Fluorescence Angiography may Contribute to Predicting Anastomotic Leakage in Gastric Cancer Surgery.

Anastomotic leak is one of the most serious postoperative complications, and intraoperative adequate perfusion plays a key role in preventing its development in gastric cancer surgery. This study aimed to investigate the relationships between anastomotic leak and the parameters defined by an assessment of intraoperative anastomotic perfusion using a near-infrared indocyanine green (ICG) fluorescence system and to evaluate the usefulness of this ICG fluorescence assessment in gastric cancer surgery. We retrospectively reviewed data of 100 patients who underwent gastric cancer surgery. In a visual assessment based on fluorescence intensity, we classified ICG fluorescence image patterns as homogeneous, heterogeneous, or faint. In a chronological assessment, the first or second time point of ICG fluorescence appearance on one or the other side of the anastomosis was defined as FT or ST, respectively. The time difference in ICG fluorescence appearance between FT and ST was defined as TD. The relationships between anastomotic leak and the evaluated clinical factors, including the parameters identified by the ICG fluorescence assessment, were evaluated using univariate or multivariate analysis. Although no signs of leak were found by surgeons' subjective judgments, four patients developed postoperative anastomotic leak of Clavien-Dindo grade III or IV. Multivariate analysis revealed that TD was an independent predictor of anastomotic leak (odds ratio 35.361, 95% confidence interval 1.489-839.923, p = 0.027). A novel parameter identified using near-infrared ICG fluorescence assessment may be useful to predict anastomotic leak in gastric cancer surgery. UMIN Clinical Trials Registry: #UMIN000030747 ( https://www.umin.ac.jp/ctr/index.htm ).

Clinical utility of transanal indocyanine green near-infrared fluorescence imaging for evaluation of colorectal anastomotic perfusion.

Although indocyanine green (ICG) fluorescence imaging has been reported to be useful for assessing colorectal perfusion, unstable quantification remains an issue. We performed ICG fluorescence observation from the luminal side and examined the usefulness of the transanal approach. A total of 69 patients who underwent left-side colon surgery were enrolled in this cohort study. After the anastomosis had been constructed, ICG 0.2mg/kg was injected intravenously. The anastomotic site was then observed by a scope inserted transanally. The following items were examined in the areas of the anastomotic site with the highest- and lowest-fluorescence intensity: maximum fluorescence (Fmax), time from ICG injection to Fmax (Tmax), time from start of dyeing to Fmax (ΔT), and the contrast pattern of the mucosa. Anastomotic leakage (AL) occurred in nine cases. Tmax and ΔT values of the lowest-fluorescence area in the distal intestine showed significant differences in the cases with AL (P = 0.015 and P = 0.040, respectively). Regarding the contrast pattern of the mucosa of the lowest-fluorescence area in the proximal and distal intestine, the patients in whom the vessels were not depicted in the area had a significantly higher incidence of AL than those in whom vessels were depicted in the area (P = 0.031 and P = 0.030, respectively). Some of the areas in which vessels were not depicted by ICG fluorescence observation from the luminal side corresponded to the points of leakage. There were heterogeneous changes that might not be grasped by observation from the serosal side. Transanal ICG fluorescence imaging can evaluate perfusion over the entire circumference of the anastomosis in detail and aid in assessing the risk of AL. Therefore, the examination of the detailed low-perfusion area enables us to take measures for AL and to search for safer operative managements.

Fluorescence-guided detection of lymph node metastases of gastrointestinal tumors

Acorrect lymph node (LN) staging is essential in oncological surgery. Indocyanine green (ICG) near-infrared fluorescence (NIRF) guided sentinel lymph node (SLN) navigation is arelatively novel technique. The aim of this review is to analyze the impact of ICG-NIRF on identification of LN metastases of gastrointestinal tumors. The Scopus and PubMed/MEDLINE literature databases were searched and 20studies were included. The ICG-NIRF navigation of LN has been shown to enable and improve LN detection in gastrointestinal tumors; however, the mean detection, sensitivity, accuracy and false negative rates show substantial variation. This could be due to both the heterogeneous techniques applied and to the low retention of ICG by lymph nodes. Fluorescence imaging to identify LN drainage is apromising tool to improve oncological outcomes. Nonetheless, the technique requires further development in terms of hardware, software and fluorophores, which are currently being investigated.

The application of indocyanine green fluorescent navigation in laparotomy of cholecystectomy

Objective: To explore the application of indocyanine green fluorescence navigation in open cholecystectomy. Methods: Forty-eight patients with extrahepatic cholangiography who underwent open cholecystectomy in our hospital from March 2016 to February 2018 were enrolled. They were divided into the control group (24 cases) and the experimental group (24 cases) by using the random number table method. The control group was treated with conventional X-ray cholangiopancreatography, and the experimental group was treated with indocyanine green near-infrared fluorescence imaging for extrahepatic cholangiography. The cholangiography success rate, cholangiography time, cholangiography economic costs, imaging accuracy and security were compared between two groups. The operation time, intraoperative blood loss, blood transfusion amount, length of hospital stays, and hospital expenses were also compared between two groups. Results: The success rate of cholangiography (98.62% vs 97.22%) and the incidence of adverse reactions (25.00 vs 29.17) were not significantly different between the two groups (P>0.05). The cholangiography time (25.69±3.47 min vs 31.42±4.66 min), operation time (90.18±10.27 min vs 81.44±9.35 min), intraoperative blood loss (82.35±8.24 ml vs 78.14±7.82 ml), blood transfusion volume (35.19±4.77 ml vs 29.58±4.03 ml), hospitalization time (7.59±1.52 d vs 6.24±1.25 d), and hospitalization cost (12.7±3.1 thousands vs 10.4±2.5 thousands) of the experimental group were significant lower than those of the control group. The accuracy rate (92.22% vs 87.50%), sensitivity (85.71% vs 50.00%) and specificity (88.24% vs 68.75%) of cholangiography in the experimental group were significantly higher than those in the control group, with statistically significant differences (P<0.05). Conclusion: Indocyanine green fluorescent navigation is more timely and accurate than traditional X-ray cholangiography during temporary angiography in open cholecystectomy, which can effectively shorten the operation time, intraoperative blood loss, blood transfusion, hospitalization time and hospitalization expenses. It does not increase the incidence of adverse reactions, has high safety, and is worthy of clinical promotion.

Intraoperative detection of the remnant cystic duct during robot-assisted surgery using near-infrared fluorescence imaging: a case report

BackgroundPost cholecystectomy syndrome is characterized as recurrence of symptoms as experienced before cholecystectomy. In rare cases, a remnant cystic duct is causing these symptoms and occasionally surgical resection is performed. During surgery, visualization of the biliary ducts could be difficult due to inflammation and dense adhesions.Case presentationIn this article, we presented a 36-year old woman with post-cholecystectomy syndrome in which we evaluated the feasibility of near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) for visualization of the remnant cystic and common bile duct during robot-assisted surgery. Intraoperative visualization of the remnant biliary duct and other important structures was feasible, and resection of the remnant cystic duct was successfully performed under fluorescence guidance, without any complications.ConclusionsNIR fluorescence imaging of the biliary ducts using ICG does not prolong the operating time, and could potentially decrease the operation time in difficult procedures, because of easy and fast detection of the biliary tract. Furthermore, it is a non-hazardous and non-invasive technique, as it does not require use of radiation and cannot cause bile duct injury. This case illustrated that ICG NIR fluorescence imaging during difficult robot-assisted surgical procedures of the bile ducts is effective and therefore highly recommended.

Pure Laparoscopic Living Donor Right Hepatectomy Using Real-Time Indocyanine Green Fluorescence Imaging

IntroductionIn recent decades, the quantitative and technological development of laparoscopic liver resection has resulted in an extension into the transplantation area.1,2 However, laparoscopic living donor hepatectomy is still in its infancy due to technical difficulties and extreme caution regarding donor safety.3 Several experienced major centers have demonstrated the feasibility and safety of laparoscopic living donor hepatectomy, and recent advances in laparoscopic imaging technology support this move.4 In particular, indocyanine green near-infrared fluorescence imaging helps determine the correct liver parenchyma anatomical resection and the exact point of bile duct division.4-6 This video demonstrates the technique of pure laparoscopic living donor right hepatectomy and the usefulness of indocyanine green fluorescence imaging. MethodsThe donor was a 32-year-old gentleman who decided to donate part of his liver to his wife who was suffering from viral liver cirrhosis and hepatocellular carcinoma. His BMI was 20.3 kg/m2 and the preoperatively estimated donor’s right liver volume was 836 ml, representing 63.6% of his entire liver. With the recipient’s weight of 57 kg, the graft-to-recipient weight ratio (GRWR) was 1.6%. The liver had classic hilar anatomy except that the right posterior intrahepatic duct was joined separately to the left main hepatic duct. The patient setting and the placement of the trocars were the same as for our conventional laparoscopic right hepatectomy technique.7 After right hepatic artery and portal vein isolation and clamping, 2.5 mg of indocyanine green was injected intravenously. ResultsTotal operation time was 370 min and estimated blood loss was 150 ml without transfusion. Indocyanine green fluorescence imaging clearly demonstrated the anatomical demarcation between the lobes and visualized the running of the biliary tree. His postoperative course was uneventful, and he was discharged on postoperative day 7. ConclusionReal-time indocyanine green fluorescence imaging may be particularly helpful for delineating the anatomical surgical plane and determining the appropriate division point of the hepatic duct during laparoscopic living donor hepatectomy.

Pure 3D laparoscopy versus open right hemihepatectomy in a donor with type II and III portal vein variations.

Backgrounds/AimsPure laparoscopic living donor right hemihepatectomy (PLDRH) has been performed in many experienced centers. However, portal vein variations still remain challenging thus disturbing the widespread of PLDRH in many centers. PLDRH when integrated with 3-dimensional laparoscopy and indocyanine green (ICG) near-infrared fluorescence cholangiography is safe and feasible.MethodsWe reviewed 19 donors with separated right anterior and right posterior portal veins who underwent living donor right hemihepatectomy between January 2014 and December 2016. We compared the clinical outcomes of PLDRH and conventional open right hemihepatectomy (CDRH).Results6 donors (31.6%) underwent PLDRH while 13 donors (68.4%) underwent CDRH. There was no intraoperative complications, transfusions and open conversions in the PLDRH donors. The total operative time was longer in PLDRH (356.5 vs. 244.5 minutes, p=0.003). However, the length of hospital stay (8.5 vs. 9.0 days, p=0.703), blood loss (450.0 vs. 393.6 ml, p=0.557) and complication rate (16.6% vs.27.3%; p=0.327) did not differ between the two groups.ConclusionsPLDRH is safe and feasible in donors with type II and III portal vein variations. Further prospective comparative studies are needed to prove the safety and efficacy of PLDRH.

Precise anatomical laparoscopic liver resection using staining technique of portal inflow territory

Introduction: Staining technique in order to remove portal inflow territory are performed in conventional anatomical liver resection. Due to magnified caudal view, Laparoscopic liver resection (LLR)can provide better exposure on hepatic hilum than open surgery. Therefore, isolation and transection of Glissonean vessels which ramify close to hepatic hilum can be performed. However, for vessels which ramify far from hilum, it could be difficult to isolate them in hilum prior to parenchymal transection. We describe our application of staining technique in LLR, depending on the variation of portal ramification. Method: Until January 2019, we performed 14 cases of anatomical LLRs using dye staining technique. Negative staining (NS) using near-infrared fluorescence scope were made by systemic administration of Indocyanine green (ICG) after ischemia by selective inflow occlusion. Positive staining (PS) using dye injection is made by direct needle puncture into portal vein under guidance of laparoscopic ultrasonography. Result: All LLRs were successfully performed anatomically. In NS, selective inflow occlusion can be standardized for Glissonean vessels which ramify close to hepatic hilum. ICG near-infrared fluorescence scope can help to detect the ischemic area even in patients with liver cirrhosis or post-adhesiolysis, in which have unclear demarcation under usual white light of endoscope. Although, PS have been considered technically difficult under the pneumoperitoneum, we experienced successful application of PS for vessels which ramify far from hilum, using our original modification tool under guidance of laparoscopic ultrasonography. Conclusion: Staining technique of portal inflow territory could contribute to perform precise anatomical laparoscopic liver resection.

Potential of indocyanine green near-infrared fluorescence imaging in experimental and clinical practice.

Visualization of Indocyanine Green (ICG) near-infrared (NIR) fluorescence is a promising technique for biomedical applications because of its deep tissue penetration, low autofluorescence, weak dependence on ambient light, safety for patients and medical staff. To apply this technique to animal studies and clinical practice, we developed multispectral NIR fluorescence imaging system FLUM-808, which can be used in experimental studies and clinical practice, in open and endoscopic surgery (fluorescence-guided surgery). The object is illuminated either directly or through an illumination channel depending on what optical instrument is used (camera lens, fiber endoscope, rigid endoscope, surgical microscope, etc.). The system is able to simultaneously display NIR images and images captured under white light. This article provides examples of imaging techniques used during open and endoscopic surgery with ICG as an NIR fluorescent dye and photosensitizer, demonstrates applications of the technique for experimental and clinical purposes: for intraoperative imaging of blood and lymphatic vessels; for detection of tumors and sentinel lymph nodes; for assessment of tissue, organ, or anastomotic blood supply. This method significantly helps to accurately assign the areas of increased fluorescence to certain anatomical structures during surgery. NIR fluorescence diagnosis can be used in important experimental studies and in clinical practice. The described results of ICG studies can help in developing new fluorescence-based diagnostic and theranostic approaches employing more effective exogenous fluorophores and photosensitizers.

Real time cholangiography using indocyanine green near-infrared fluorescence imaging in living donor hepatectomy

Real time cholangiography using indocyanine green near-infrared fluorescence imaging in living donor hepatectomy

Sentinel node navigation surgery using near-infrared indocyanine green fluorescence in early gastric cancer

The aim of this study was to evaluate the feasibility of indocyanine green (ICG) fluorescent method for sentinel lymph node detection in early gastric cancer. Between December 2012 and December 2014, 28 cases of pilot examination were performed at Seoul National University Bundang Hospital. Advanced version of multispectral fluorescence organoscope was used to identify sentinel node by quantitative estimation of ICG fluorescent signal intensity. Sensitivity, specificity, false positive value were analyzed and compared with dual tracer method. A total of 443 lymph nodes in 28 cases were examined and 184 sentinel nodes (41.5%) were identified by dual tracer method. The sensitivity using near-infrared ICG method was 98.9%. The specificity was 76.0% and false positive rate was 25.4% compared with dual tracer method. The adequate threshold for sentinel node detection was considered as 10% of maximum signal intensity. New near-infrared ICG fluorescent method could be a promising protocol for sentinel node navigation surgery in early gastric cancer.

Comparative Study of Pure Laparoscopic Donor Right Hemihepatectomy and Open Donor Right Hemihepatectomy in Patients with Separate Right Anterior and Right Posterior Portal Veins

Introduction Pure laparoscopic living donor right hemihepatectomy (PLDRH) has been performed in several experienced center. But, Anatomical variation of portal veins still could be one of the reasons for the hesitation to perform PLDRH. We reported that pure laparoscopic donor right hemihepatectomy; integrated with 3D laparoscopy and indocyanine green (ICG) near-infrared fluorescence cholangiography is safe and good modality for patients had separate right anterior and right posterior portal veins. Method We performed living donor right hemihepatectomy in 19 donors who had separated right anterior and right posterior portal veins between January 2014 and December 2016. We excluded 2 laparoscopic assisted hepatectomy cases and compared the clinical outcomes of pure laparoscopic donor right hemihepatectomy (PLDRH) and conventional open right hemihepatectomy (CDRH) groups. Results None of the 6 PLDRH donors had intraoperative complications and none required transfusions, reoperation, or conversion to open hepatectomy. The total operative time was longer (356.5 vs. 244.5 minutes; P=0.003). However, the length of postoperative hospital stay (8.5 vs. 9.0 days; P=0.703) and blood loss (450.0 vs. 393.6 ml; P=0.557) and complication rate (33.3% vs. 27.3%; P=0.515) were similar in both groups. Conclusion Pure 3D laparoscopic living donor right hemihepatectomy is feasible in a donor with separate right anterior and right posterior portal veins.

Sentinel lymph node biopsy in cutaneous melanoma of the head and neck using the indocyanine green SPY Elite system

PurposeLymph node status is the single most important prognostic factor for patients with early-stage cutaneous melanoma. Sentinel lymph node biopsy (SLNB) has become the standard of care for intermediate depth melanomas. Modern SLNB implementation includes technetium-99 lymphoscintigraphy combined with local administration of a vital blue dye. However, sentinel lymph nodes may fail to localize in some cases and false-negative rates range from 0 to 34%. Here we demonstrate the feasibility of a new sentinel lymph node biopsy technique using indocyanine green (ICG) and the SPY Elite near-infrared imaging system. Materials and methodsCases of primary cutaneous melanoma of the head and neck without locoregional metastasis, underwent SLNB at a single quaternary care institution between May 2016 and June 2017. Intraoperatively, 0.25 mL of ICG was injected intradermal in 4 quadrants around the primary lesion. 10–15 minute circulation time was permitted. SPY Elite identified the sentinel lymph node within the nodal basin marked by lymphoscintigraphy. Target first echelon lymph nodes were confirmed with a gamma probe and ICG fluorescence. Results14 patients were included with T1a to T4b cutaneous melanomas. Success rates for sentinel lymph node identification using lymphoscintigraphy and the SPY Elite system were both 86%. Zero false negatives occurred. Median length of follow-up was 323 days. ConclusionsIn this pilot study, Indocyanine green near-infrared fluorescence demonstrates a safe, and facile method of sentinel lymph node biopsy for cutaneous melanoma of the head and neck compared with lymphoscintigraphy and vital blue dyes.

Pediatric Living Donor Liver Transplantation Using a Monosegment Procured by Pure 3D Laparoscopic Left Lateral Sectionectomy and In situ Reduction

BackgroundImprovements in laparoscopic imaging systems and instruments have increased the performance of pure laparoscopic living donor hepatectomy. This operation is no longer limited to left lateral sectionectomy but is used for left hepatectomy and right hepatectomy.1-5 This report describes a donor who underwent pure laparoscopic left lateral sectionectomy and in situ reduction using 3D laparoscopy and indocyanine green (ICG) near-infrared fluorescence cholangiography to obtain a monosegment. MethodsA 43-year-old woman offered to donate part of her liver to her daughter, who required a transplant for acute liver failure after a Kasai operation for biliary cirrhosis caused by biliary atresia. Donor height was 150.4 cm, body weight was 56.8 kg, and body mass index was 25.1 kg/m2. Liver dynamic CT showed a left lateral liver volume of 223 cm3, and an estimated graft-to-recipient weight ratio (GRWR) of 4.4%. The entire procedure including in situ reduction was performed under 3D laparoscopic view. The optimal bile duct division point was determined by real time ICG fluorescence cholangiography. ResultsThe total operation time was 320 min, with no transfusion required and no intraoperative complications. Intraoperative real time ICG fluorescence cholangiography revealed the donor’s bile duct anatomy and identified the optimal division point. The final graft weighed 167 g, 48 g being reduced in situ, with a GRWR of 3.3%. The donor was discharged on postoperative day 8 with no complications. ConclusionPure 3D laparoscopic left lateral sectionectomy and in situ reduction are feasible for obtaining a donor monosegment for pediatric living donor liver transplantation.

Quantitative Primary Tumor Indocyanine Green Measurements Predict Osteosarcoma Metastatic Lung Burden in a Mouse Model.

Current preclinical osteosarcoma (OS) models largely focus on quantifying primary tumor burden. However, most fatalities from OS are caused by metastatic disease. The quantification of metastatic OS currently relies on CT, which is limited by motion artifact, requires intravenous contrast, and can be technically demanding in the preclinical setting. We describe the ability for indocyanine green (ICG) fluorescence angiography to quantify primary and metastatic OS in a previously validated orthotopic, immunocompetent mouse model. (1) Can near-infrared ICG fluorescence be used to attach a comparable, quantitative value to the primary OS tumor in our experimental mouse model? (2) Will primary tumor fluorescence differ in mice that go on to develop metastatic lung disease? (3) Does primary tumor fluorescence correlate with tumor volume measured with CT? Six groups of 4- to 6-week-old immunocompetent Balb/c mice (n = 6 per group) received paraphyseal injections into their left hindlimb proximal tibia consisting of variable numbers of K7M2 mouse OS cells. A hindlimb transfemoral amputation was performed 4 weeks after injection with euthanasia and lung extraction performed 10 weeks after injection. Histologic examination of lung and primary tumor specimens confirmed ICG localization only within the tumor bed. Mice with visible or palpable tumor growth had greater hindlimb fluorescence (3.5 ± 2.3 arbitrary perfusion units [APU], defined as the fluorescence pixel return normalized by the detector) compared with those with a negative examination (0.71 ± 0.38 APU, -2.7 ± 0.5 mean difference, 95% confidence interval -3.7 to -1.8, p < 0.001). A strong linear trend (r = 0.81, p < 0.01) was observed between primary tumor and lung fluorescence, suggesting that quantitative ICG tumor fluorescence is directly related to eventual metastatic burden. We did not find a correlation (r = 0.04, p = 0.45) between normalized primary tumor fluorescence and CT volumetric measurements. We demonstrate a novel methodology for quantifying primary and metastatic OS in a previously validated, immunocompetent, orthotopic mouse model. Quantitative fluorescence of the primary tumor with ICG angiography is linearly related to metastatic burden, a relationship that does not exist with respect to clinical tumor size. This highlights the potential utility of ICG near-infrared fluorescence imaging as a valuable preclinical proof-of-concept modality. Future experimental work will use this model to evaluate the efficacy of novel OS small molecule inhibitors. Given the histologic localization of ICG to only the tumor bed, we envision the clinical use of ICG angiography as an intraoperative margin and tumor detector. Such a tool may be used as an alternative to intraoperative histology to confirm negative primary tumor margins or as a valuable tool for debulking surgeries in vulnerable anatomic locations. Because we have demonstrated the successful preservation of ICG in frozen tumor samples, future work will focus on blinded validation of this modality in observational human trials, comparing the ICG fluorescence of harvested tissue samples with fresh frozen pathology.

Near-infrared dye marking for thoracoscopic resection of small-sized pulmonary nodules: comparison of percutaneous and bronchoscopic injection techniques

BackgroundMinimally invasive video-assisted thoracoscopic surgery for small-sized pulmonary nodules is challenging, and image-guided preoperative localisation is required. Near-infrared indocyanine green fluorescence is capable of deep tissue penetration and can be distinguished regardless of the background colour of the lung; thus, indocyanine green has great potential for use as a near-infrared fluorescent marker in video-assisted thoracoscopic surgery.MethodsThirty-seven patients with small-sized pulmonary nodules, who were scheduled to undergo video-assisted thoracoscopic wedge resection, were enrolled in this study. A mixture of diluted indocyanine green and iopamidol was injected into the lung parenchyma as a marker, using either computed tomography-guided percutaneous or bronchoscopic injection techniques. Indications and limitations of the percutaneous and bronchoscopic injection techniques for marking nodules with indocyanine green fluorescence were examined and compared.ResultsIn the computed tomography-guided percutaneous injection group (n = 15), indocyanine green fluorescence was detected in 15/15 (100%) patients by near-infrared thoracoscopy. A small pneumothorax occurred in 3/15 (20.0%) patients, and subsequent marking was unsuccessful after a pneumothorax occurred. In the bronchoscopic injection group (n = 22), indocyanine green fluorescence was detected in 21/22 (95.5%) patients. In 6 patients who underwent injection marking at 2 different lesion sites, 5/6 (83.3%) markers were successfully detected.ConclusionEither computed tomography-guided percutaneous or bronchoscopic injection techniques can be used to mark pulmonary nodules with indocyanine green fluorescence. Indocyanine green is a safe and easily detectable fluorescent marker for video-assisted thoracoscopic surgery. Furthermore, the bronchoscopic injection approach enables surgeons to mark multiple lesion areas with less risk of causing a pneumothorax.Trial RegistrationUMIN-CTR R000027833 accepted by ICMJE. Registered 5 January 2013.

Laparoscopic Minimally Invasive Approach to Sentinel Lymph Node Mapping of the Ovary Using the Near-infrared Fluorescent S1 HD Pinpoint System with Indocyanine Green Dye

Study ObjectiveTo show a novel minimally invasive approach to sentinel lymph node (SLN) detection of the ovary with near-infrared–guided surgery using indocyanine green (ICG). DesignA step by step description of the technique with video and figures (educational video). SettingThe standard surgical staging of early-stage I-II ovarian cancer includes systematic pelvic and aortic lymphadenectomy even in the absence of clear evidence regarding the survival benefits associated with comprehensive retroperitoneal staging. The ideal candidates are all women undergoing a surgical approach with frozen section analysis for highly suspicious ovarian masses or patients in whom an adnexal mass has been removed that appeared to be malignant and an open or laparoscopic surgical staging procedure is planned. PatientA 31-year-old woman with occult ovarian cancer after simple left ovarian cystectomy. InterventionsLaparoscopic surgical staging including simple hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and aortic bilateral lymphadenectomy, and sentinel node biopsy from the left ovary. Measurements and Main ResultsThe surgical intervention was performed with the PinPoint 0 degree HD S1 SPY fluorescence camera (PinPoint Endoscopic Fluorescence Imaging System; NOVADAQ, Mississauga, ON, Canada). After the induction of the pneumoperitoneum, ICG was injected with 2 separate injections in the proper ovarian ligament and the infundibulopelvic ligament, just below the peritoneum, at a concentration of 1.25 mg/mL. A total amount of 0.4 mL ICG solution was injected using a percutaneous abdominal approach with a 12-cm-long 22-G spinal needle. SLN mapping should be preceded by the exposure of the aortic region with a gentle dissection on both sides along the Toldt fascia up to the left renal vein. Two SLNs were identified in the left inframesenteric para-aortic and superficial left common areas. Both SLNs were negative. ConclusionThe minimally invasive approach in combination with the ICG near-infrared fluorescence S1 PinPoint fluorescence system seems feasible, and, in our opinion, even if preliminary, this approach can further extend the range of indications of SLN mapping. In the future, this combined approach can prospectively involve ovarian SLN detection.

The role of sentinel node mapping with indocyanine green and endoscopic near-infrared fluorescence imaging in endometrial and cervical cancer.

Endometrial and cervical carcinoma are common neoplasms in gynecological oncology. The prognosis and treatment depend on the stage of the cancer according to the FIGO staging system. Stage IAl may be treated by hysterectomy or even local surgical procedures. For Stage IA2, radical hysterectomy and lymphadenectomy must be performed. Lymph node metastasis is an important prognostic factor in both cancers, however lymphadenectomy is associated with long-term complications. Thanks to the sentinel lymph node biopsy (SLNB), we can more accurately discover the staging of the primary tumor, and in case of sentinel lymph node (SLN) negative patients, can resign regional lymphadenectomy. Some researchers claim that new techniques such as indocyanine green (ICG) and endoscopic near-infrared fluorescence imaging for sentinel node mapping can be used instead of the traditional techniques. To establish the role of sentinel node mapping technique in endometrial and cervical cancer. A retrospective study of medical records of five patients with cervical cancer (first group) Stage I and nine patients (second group) who underwent laparoscopic radical hysterectomy and SLNB or group of lymph nodes. These procedures were performed at Gynecology Department of the District Hospital in Garwolin. All lymph nodes were clear of metastases. All patients after histopathological diagnosis were finally referred to the Cancer Centre and Institute of Oncology due to consultation or for further treatment. Based on the present first results and literature review, intracervical ICG injection with fluorescence imaging seems to be the best SLN mapping technique, because of its simplicity, safety, and overall lower cost. More data is required to determine if the nodes identified with this technique are able to predict metastatic disease.

Sensitivity and specificity of indocyanine green near-infrared fluorescence imaging in detection of metastatic lymph nodes in colorectal cancer: Systematic review and meta-analysis.

This review aimed to determine the overall sensitivity and specificity of indocyanine green (ICG) near-infrared (NIR) fluorescence in sentinel lymph node (SLN) detection in Colorectal cancer (CRC). A systematic search in electronic databases was conducted. Twelve studies including 248 patients were reviewed. The median sensitivity, specificity, and accuracy rates were 73.7, 100, and 75.7. The pooled sensitivity and specificity rates were 71% and 84.6%. In conclusion, ICG-NIR fluorescence is a promising technique for detecting SLNs in CRC.

Pure 3D laparoscopic living donor right hemihepatectomy in a donor with separate right posterior and right anterior hepatic ducts and portal veins

BackgroundDespite increases in the performance of pure laparoscopic living donor hepatectomy, variations in the bile duct or portal vein have been regarded as relative contraindications to this technique [1–3]. This report describes a donor with separate right posterior and right anterior hepatic ducts and portal veins who underwent pure laparoscopic living donor right hemihepatectomy, integrated with 3D laparoscopy and indocyanine green (ICG) near-infrared fluorescence cholangiography [1, 4, 5].MethodsA 50-year-old man offered to donate part of his liver to his older brother, who required a transplant for hepatitis B-associated liver cirrhosis and hepatocellular carcinoma. Donor height was 178.0 cm, body weight was 82.7 kg, and body mass index was 26.1 kg/m2. Preoperative computed tomography and magnetic resonance cholangiopancreatography showed that the donor had separate right posterior and right anterior hepatic ducts and portal veins. The entire procedure was performed under 3D laparoscopic view. Following intravenous injections of 0.05 mg/kg ICG, ICG near-infrared fluorescence camera was used to demarcate the exact transection line and determine the optimal bile duct division point.ResultsThe total operation time was 443 min; the donor required no transfusions and experienced no intraoperative complications. The graft weighed 1146 g with a graft-to-recipient weight ratio of 1.88%. The optimal bile duct division point was identified using ICG fluorescence cholangiography, and the bile duct was divided with good patency without any stricture. The right anterior and posterior portal veins were transected with endostaplers without any torsion. The patient was discharged on postoperative day 8, with no complications.ConclusionUsing a 3D view and ICG fluorescence cholangiography, pure 3D laparoscopic living donor right hemihepatectomy is feasible in a donor with separate right posterior and right anterior hepatic ducts and portal veins.