title: A feasibility study of NIR fluorescent image-guided surgery in head and neck cancer based on the assessment of optimum surgical time as revealed through dynamic imaging.
abstract: BACKGROUND
  In order to minimize surgical stress and preserve organs, endoscopic or robotic surgery is often performed when conducting head and neck surgery. However, it is impossible to physically touch tumors or to observe diffusely invaded deep organs through the procedure of endoscopic or robotic surgery. In order to visualize and safely resect tumors even in these cases, we propose using an indocyanine green (ICG) fluorescence method for navigation surgery in head and neck cancer.
  
  
  OBJECTIVE
  To determine the optimum surgical time for tumor resection after the administration of ICG based on the investigation of dynamic ICG fluorescence imaging.
  
  
  METHODS
  Nine patients underwent dynamic ICG fluorescence imaging for 360 minutes, assessing tumor visibility at 10, 30, 60, 120, 180, and 360 minutes. All cases were scored according to near-infrared (NIR) fluorescence imaging visibility scored from 0 to 5.
  
  
  RESULTS
  Dynamic NIR fluorescence imaging under the HyperEye Medical System indicated that the greatest contrast in fluorescent images between tumor and normal tissue could be observed from 30 minutes to 1 hour after the administration of ICG. The optimum surgical time was determined to be between 30 minutes to 2 hours after ICG injection. These findings are particularly useful for detection and safe resection of tumors invading the parapharyngeal space.
  
  
  CONCLUSIONS
  ICG fluorescence imaging is effective for the detection of head and neck cancer. Preliminary findings suggest that the optimum timing for surgery is from 30 minutes to 2 hours after the ICG injection.
authors: Department of Otolaryngology-Head and Neck Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors: Junkichi
authors: J
authors: Yokoyama
authors: Mitsuhisa
authors: M
authors: Fujimaki
authors: Shinichi
authors: S
authors: Ohba
authors: Takashi
authors: T
authors: Anzai
authors: Ryota
authors: R
authors: Yoshii
authors: Shin
authors: S
authors: Ito
authors: Masataka
authors: M
authors: Kojima
authors: Katsuhisa
authors: K
authors: Ikeda
keywords: endoscopic surgery; indocyanine green (ICG); minimally invasive surgery; navigation surgery; robotic surgery
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