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Review
. 2012 Nov;19(6):626-37.
doi: 10.1007/s00534-012-0534-6.

Image-guided hepatopancreatobiliary surgery using near-infrared fluorescent light

Floris P R Verbeek  1 , Joost R van der Vorst, Boudewijn E Schaafsma, Merlijn Hutteman, Bert A Bonsing, Fijs W B van Leeuwen, John V Frangioni, Cornelis J H van de Velde, Rutger-Jan Swijnenburg, Alexander L Vahrmeijer
Affiliations
Review

Image-guided hepatopancreatobiliary surgery using near-infrared fluorescent light

Floris P R Verbeek et al. J Hepatobiliary Pancreat Sci. 2012 Nov.

Abstract

Background: Improved 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.

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 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.

Conclusions: NIR fluorescence imaging is a promising new technique that may someday improve surgical accuracy and lower complications.

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Figures

Fig. 1
Fig. 1
NIR fluorescence imaging of colorectal liver metastases using the Mini-FLARE imaging system: a colorectal liver metastasis (arrow) is clearly identified by a NIR fluorescent rim around the tumour in vivo (top row), 24 h after injection of 10-mg ICG. Normal liver tissue (arrowhead) shows minimal retention of ICG. After resection and slicing of the specimen, the rim around the tumour is better visualized ex vivo (bottom row) (van der Vorst et al., unpublished data)
Fig. 2
Fig. 2
Laparoscopic NIR fluorescence imaging of a hepatocellular carcinoma: a Colour image (left) and fluorescent image (right) of the visceral surface of the left liver before mobilization. Fluorescent imaging clearly delineated the hepatocellular carcinoma located in segment II, with the surrounding structures. b The left liver was fully mobilized and the lesser omentum was sectioned, using NIR fluorescence imaging to confirm the appropriateness of the resection margin of the tumour (adapted from Ishizawa et al. [31] and reprinted with permission from John Wiley & Sons, Inc)
Fig. 3
Fig. 3
NIR fluorescence imaging of the bile duct during liver surgery: colour video (left panel), NIR fluorescence (middle panel), and a colour-NIR overlay (right panel) of intraoperative imaging of the cystic duct (arrowhead) and common bile duct (arrow) in a patient who underwent liver resection for colorectal metastases, 24 h after administration of 10-mg ICG. The asterisk indicates the position of the gallbladder
See this image and copyright information in PMC

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