Usefulness of intraoperative fluorescence imaging to evaluate local anatomy in hepatobiliary surgery

• Published in: Journal of Hepato‐Biliary‐Pancreatic Surgery Vol. 15; no. 5; pp. 508 - 514
• Main Authors: Mitsuhashi, Noboru, Kimura, Fumio, Shimizu, Hiroaki, Imamaki, Mizuho, Yoshidome, Hiroyuki, Ohtsuka, Masayuki, Kato, Atsushi, Yoshitomi, Hideyuki, Nozawa, Satoshi, Furukawa, Katsunori, Takeuchi, Dan, Takayashiki, Tsukasa, Suda, Kosuke, Igarashi, Tatsuo, Miyazaki, Masaru
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.09.2008
• Subjects: Abdominal Surgery; Animals; biliary tract; Biliary Tract - anatomy & histology; Biliary Tract Surgical Procedures; cholangiogram; Cholecystectomy; Coloring Agents; Fluorescence; fluorescence imaging; Gastroenterology; Hepatology; Humans; In Vitro Techniques; indocyanine green; Indocyanine Green - analogs & derivatives; infrared camera; Infrared Rays; Laparotomy; Liver - anatomy & histology; Liver - surgery; Liver Transplantation; Male; Medicine; Medicine & Public Health; Original Article; Surgical Oncology; Swine; Cholangiogram; Biliary tract; Indocyanine green; Fluorescence imaging; Infrared camera
• ISSN: 0944-1166; 1436-0691; 1868-6982
• DOI: 10.1007/s00534-007-1307-5

Background/Purpose One of the major complications encountered in hepatobiliary surgery is the incidence of bile duct and blood vessel injuries. It is sometimes difficult during surgery to evaluate the local anatomy corresponding to hepatic arteries and bile ducts. We investigated the potential utility of an infrared camera system as a tool for evaluating local anatomy during hepatobiliary surgery. Methods An infrared camera system was used to detect indocyanine green fluorescence in vitro. We also employed this system for the intraoperative fluorescence imaging of the arteries and biliary system in a pig. Further, we evaluated blood flow in the hepatic artery, portal vein, and liver parenchyma during a human liver transplant and we investigated local anatomy in patients undergoing cholecystectomy. Results Fluorescence confirmed that indocyanine green was distributed in serum and bile. In the pig study, we confirmed the fluorescence of the biliary system for more than 1 h. In the liver transplant recipient, blood flow in the hepatic artery and portal vein was confirmed around the anastomosis. In most of the patients undergoing cholecystectomy, fluorescence was observed in the gallbladder, cystic and common bile ducts, and hepatic and cystic arteries. Conclusions Intraoperative fluorescence imaging in hepatobiliary surgery facilitates better understanding of the anatomy of arteries, the portal vein, and bile ducts.