Abstract
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.
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References
Taggart DP, Choudhary B, Anastasiadis K, Abu-Omar Y, Balacumaraswami L, Pigott DW. Preliminary experience with a novel intraoperative fluorescence imaging technique to evaluate the patency of bypass grafts in total arterial revascularization. Ann Thorac Surg 2003;75:870–873.
Reuthebuch OT, Kadner A, Lachat ML, Turina MI. Graft occlusion after deployment of the Symmetry Bypass System. Ann Thorac Surg 2003;75:1626–1629.
Unno N, Inuzuka K, Suzuki M, Yamamoto N, Sagara D, Nishiyama M, et al. Preliminary experience with a novel fluorescence lymphography using indocyanine green in patients with secondary lymphedema. J Vasc Surg 2007;45:1016–1021.
Woitzik J, Horn P, Vajkoczy P, Schmiedek P. Intraoperative control of extracranial-intracranial bypass patency by near-infrared indocyanine green videoangiography. J Neurosurg 2005;102:692–698.
Sekijima M, Tojimbara T, Sato S, Nakamura M, Kawase T, Kai K, et al. An intraoperative fluorescent imaging system in organ transplantation. Transplant Proc 2004;36:2188–2190.
Kubota K, Kita J, Shimoda M, Rokkaku K, Kato M, Iso Y, et al. Intraoperative assessment of reconstructed vessels in living-donor liver transplantation, using a novel fluorescence imaging technique. J Hepatobiliary Pancreat Surg 2006;13:100–104.
Kimura T, Suzuki K, Umehara Y, Kawabe A, Wada H. Features and management of bile leaks after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 2005;12:61–64.
Kimura Y, Hirata K, Mukaiya M, Mizuguchi T, Nobuoka T, Furuhata T et al. Biliary injury after laparoscopic cholecystectomy: end-to-end anastomosis covered with umbilical vein. J Hepatobiliary Pancreat Surg 2005;12:269–271.
Wheeler HO, Cranston WI, Meltzer JI. Hepatic uptake and biliary excretion of indocyanine green in the dog. Proc Soc Exp Biol Med 1958;99:11–14.
Cherrick GR, Stein SW, Leevy CM, Davidson CS. Indocyanine green: observations on its physical properties, plasma decay, and hepatic extraction. J Clin Invest 1960;39:592–600.
Caesar J, Shaldon S, Chiandussi L, Guevara L, Sherlock S. The use of indocyanine green in the measurement of hepatic blood flow and as a test of hepatic function. Clin Sci 1961;21:43–57.
Speich R, Saesseli B, Hoffmann U, Neftel KA, Reichen J. Anaphylactoid reactions after indocyanine-green administration. Ann Intern Med 1988;109:345–346.
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Mitsuhashi, N., Kimura, F., Shimizu, H. et al. Usefulness of intraoperative fluorescence imaging to evaluate local anatomy in hepatobiliary surgery. J Hepatobiliary Pancreat Surg 15, 508–514 (2008). https://doi.org/10.1007/s00534-007-1307-5
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DOI: https://doi.org/10.1007/s00534-007-1307-5