Usefulness of intraoperative fluorescence imaging to evaluate local anatomy in hepatobiliary surgery.
OBJECTIVE
One of the major complications encountered in hepatobiliary surgery is the incidence of bile duct and blood vessel injuries. It is sometimes difficult during surgery to evaluate the local anatomy corresponding to hepatic arteries and bile ducts. We investigated the potential utility of an infrared camera system as a tool for evaluating local anatomy during hepatobiliary surgery.


METHODS
An infrared camera system was used to detect indocyanine green fluorescence in vitro. We also employed this system for the intraoperative fluorescence imaging of the arteries and biliary system in a pig. Further, we evaluated blood flow in the hepatic artery, portal vein, and liver parenchyma during a human liver transplant and we investigated local anatomy in patients undergoing cholecystectomy.


RESULTS
Fluorescence confirmed that indocyanine green was distributed in serum and bile. In the pig study, we confirmed the fluorescence of the biliary system for more than 1 h. In the liver transplant recipient, blood flow in the hepatic artery and portal vein was confirmed around the anastomosis. In most of the patients undergoing cholecystectomy, fluorescence was observed in the gallbladder, cystic and common bile ducts, and hepatic and cystic arteries.


CONCLUSIONS
Intraoperative fluorescence imaging in hepatobiliary surgery facilitates better understanding of the anatomy of arteries, the portal vein, and bile ducts.
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Noboru
N
Mitsuhashi
Fumio
F
Kimura
Hiroaki
H
Shimizu
Mizuho
M
Imamaki
Hiroyuki
H
Yoshidome
Masayuki
M
Ohtsuka
Atsushi
A
Kato
Hideyuki
H
Yoshitomi
Satoshi
S
Nozawa
Katsunori
K
Furukawa
Dan
D
Takeuchi
Tsukasa
T
Takayashiki
Kosuke
K
Suda
Tatsuo
T
Igarashi
Masaru
M
Miyazaki
D000818:Animals; D001659:Biliary Tract / Q000033:anatomy & histology*; D001662:Biliary Tract Surgical Procedures; D002763:Cholecystectomy; D004396:Coloring Agents; D005453:Fluorescence; D006801:Humans; D066298:In Vitro Techniques; D007208:Indocyanine Green / Q000031:analogs & derivatives; D007259:Infrared Rays; D007813:Laparotomy; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D013552:Swine
D004396:Coloring Agents; C116320:Infracyanine green; D007208:Indocyanine Green