title: Near-infrared fluorescence imaging in patients undergoing pancreaticoduodenectomy.
abstract: BACKGROUND
  Intraoperative visualization of pancreatic tumors has the potential to improve radical resection rates. Intraoperative visualization of the common bile duct and bile duct anastomoses could be of added value. In this study, we explored the use of indocyanine green (ICG) for these applications and attempted to optimize injection timing and dose.
  
  
  METHODS
  Eight patients undergoing a pancreaticoduodenectomy were injected intravenously with 5 or 10 mg ICG. During and after injection, the pancreas, tumor, common bile duct and surrounding organs were imaged in real time using the Mini-FLARE™ near-infrared (NIR) imaging system.
  
  
  RESULTS
  No clear tumor-to-pancreas contrast was observed, except for incidental contrast in 1 patient. The common bile duct was clearly visualized using NIR fluorescence, within 10 min after injection, with a maximal contrast between 30 and 90 min after injection. Patency of biliary anastomoses could be visualized due to biliary excretion of ICG.
  
  
  CONCLUSIONS
  No useful tumor demarcation could be visualized in pancreatic cancer patients after intravenous injection of ICG. However, the common bile duct and biliary anastomoses were clearly visualized during the observation period. Therefore, these imaging strategies could be beneficial during biliary surgery in cases where the surgical anatomy is aberrant or difficult to identify.
authors: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors: M
authors: M
authors: Hutteman
authors: J R
authors: JR
authors: van der Vorst
authors: J S D
authors: JS
authors: Mieog
authors: B A
authors: BA
authors: Bonsing
authors: H H
authors: HH
authors: Hartgrink
authors: P J K
authors: PJ
authors: Kuppen
authors: C W G M
authors: CW
authors: Löwik
authors: J V
authors: JV
authors: Frangioni
authors: C J H
authors: CJ
authors: van de Velde
authors: A L
authors: AL
authors: Vahrmeijer
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003135:Common Bile Duct / Q000473:pathology / Q000601:surgery; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D007259:Infrared Rays; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green