Image-guided hepatopancreatobiliary surgery using near-infrared fluorescent light.
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.
Department of Surgery, University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
Floris P R
FP
Verbeek
Joost R
JR
van der Vorst
Boudewijn E
BE
Schaafsma
Merlijn
M
Hutteman
Bert A
BA
Bonsing
Fijs W B
FW
van Leeuwen
John V
JV
Frangioni
Cornelis J H
CJ
van de Velde
Rutger-Jan
RJ
Swijnenburg
Alexander L
AL
Vahrmeijer
D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000601:surgery*; D003952:Diagnostic Imaging / Q000379:methods; D005456:Fluorescent Dyes; D006801:Humans; D007259:Infrared Rays / Q000627:therapeutic use*; D010535:Laparoscopy / Q000379:methods; D008107:Liver Diseases / Q000175:diagnosis / Q000601:surgery*; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000601:surgery*; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*
D005456:Fluorescent Dyes