Ultrasonography-guided hepatic tumor resection using a real-time virtual sonography with indocyanine green navigation (with videos).
OBJECTIVE
For hepatic tumors that cannot be identified on routine ultrasonography (US), we marked the target area using real-time virtual sonography (RVS) with indocyanine green (ICG)-ethanol (1:100) during surgery, and performed hepatic resection while observing the fluorescence.


METHODS
An ICG-ethanol mixture locally injected into mouse liver was retained in the same area for more than 4 h. The same mixture locally injected into pig liver at a depth of 3 cm could be observed using an infrared camera.


METHODS
An ICG-ethanol mixture (500 μl) was locally injected under RVS guidance into a metastatic hepatic tumor that was visible only on magnetic resonance imaging (MRI), and hepatic resection was performed while Photodynamic Eye (PDE) images were being observed. The metastatic lesion (3 mm in diameter in a pathological specimen) could be successfully resected.


CONCLUSIONS
This method was useful for resecting US-invisible hepatic tumors.
3rd Department of Digestive Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. kasuya-k@jcom.home.ne.jp
Kazuhiko
K
Kasuya
Katsutoshi
K
Sugimoto
Bunsoh
B
Kyo
Yuichi
Y
Nagakawa
Takahisa
T
Ikeda
Yasuharu
Y
Mori
Tatehiko
T
Wada
Minako
M
Suzuki
Takeshi
T
Nagai
Takao
T
Itoi
Motohide
M
Shimazu
Tatsuya
T
Aoki
Akihiko
A
Tsuchida
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004396:Coloring Agents; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D011859:Radiography; D014584:User-Computer Interface
D004396:Coloring Agents; D007208:Indocyanine Green