Intraoperative fluorescent imaging using indocyanine green for liver mapping and cholangiography.
BACKGROUND
Preoperative imaging is widely used and extremely helpful in hepatobiliary surgery. However, transfer of preoperative data to a intraoperative situation is very difficult. Surgeons need intraoperative anatomical information using imaging data for safe and precise operation in the field of hepatobiliary surgery. We have developed a new system for mapping liver segments and cholangiograms using intraoperative indocyanine green (ICG) fluorescence under infrared light observation.


METHODS
The imaging technique for mapping liver segments and cholangiogram based on ICG fluorescence used an infrared-based navigation system. Eighty one patients with liver tumors underwent hepatectomy from 2006, January to 2009, March. In liver surgery, 1 ml of ICG was injected via the portal vein under observation by the fluorescent imaging system. Fourteen patients were underwent laparoscopic cholecystectomy for chronic cholecystitis with gallstones. In laparoscopic cholecystectomy, 5 ml of ICG was administered intravenously just before operation and the bile duct was observed using the infrared-based navigation system.


RESULTS
This new technique successfully identified stained subsegments and segments of the liver in 73 of 81 patients (90.1%). Moreover, clear mapping of liver segments was obtained even against a background of liver cirrhosis. Fluorescent cholangiography clearly showed the common bile duct and cystic duct in 10 of 14 patients (71.4%). No adverse reactions to the ICG were encountered.


CONCLUSIONS
Application of this technique allows intraoperative identification of anatomical landmark in hepatobiliary surgery.
Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, 142-8666, Japan. takejp@wb4.so-net.ne.jp
Takeshi
T
Aoki
Masahiko
M
Murakami
Daisuke
D
Yasuda
Yoshinori
Y
Shimizu
Tomokazu
T
Kusano
Kazuhiro
K
Matsuda
Takashi
T
Niiya
Hirohisa
H
Kato
Noriyuki
N
Murai
Koji
K
Otsuka
Mitsuo
M
Kusano
Takashi
T
Kato
D000328:Adult; D000368:Aged; D002758:Cholangiography / Q000295:instrumentation*; D004396:Coloring Agents; D004867:Equipment Design; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D020706:Laparoscopes; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies
D004396:Coloring Agents; D007208:Indocyanine Green