Abstract
ICG fluorescence image-guided surgery has been used as a less invasive approach for sentinel lymph node navigation surgery operations. Recently, we found that fluorescence image can obtain immediately after a mixture of ICG and bile juice, which has not been reported yet. Furthermore, we happened to observe the ICG fluorescence image of cholangiogram when we performed hepatectomy on the patient with liver cancer, because he had received ICG test for the evaluation of liver function test prior to the operation. Based on these facts, we applied (ICG) fluorescence imaging by emitting diode showed the usefulness for the imaging of intraoperative cholangiography. In our preliminary animal study, we could find shining the ICG fluorescence image of cholangiogram following the injection of ICG into cystic duct. The gallbladder, cystic duct and common bile duct were clearly demonstrated. We could observe these images using PDE camera at laparotomy as well as by the newly devised ICG fluorescence-image endoscope (FIE) for laparoscopic cholecystectomy. The intensity of ICG fluorescence detected by the PDE camera is superior to that by FIE. Clinically, we applied FIE for patients who underwent laparoscopic cholecystectomy as follows. Prior to dissection of cystic duct, 1-2ml of ICG solution was directly injected into gallbladder, using Kurmar forceps. We found fluorescence image along with the biliary tract clearly. Rather similar results were obtained when we injected systemically 10ml ICG solution several hours prior to the operation, we could not obtained the fine image of cholangiography when the cystic duct and common bile duct were covered with thick fat tissue, In our preliminary animal and clinical study, we confirmed that ICG fluorescence image-guided intraoperative cholangiography is promising approach for laparoscopic cholecystectomy or biliary reconstruction in hepato-pancreatico-biliary surgery without using conventional X-ray image system.
