Hepatectomy using a novel cart-based indocyanine green fluorescence imaging system
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Hepatectomy using a novel cart‑based indocyanine green fluorescence imaging system Seikan Miyashita1 · Etsuro Hatano1 · Masaharu Tada1 · Toshihiro Okada1 Received: 2 January 2020 / Accepted: 17 March 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Indocyanine green (ICG) fluorescence has been used effectively in imaging for locating hepatic tumors and evaluating hepatic segmentation. We report our initial experience of performing hepatic resection using the novel cart-based ICG fluorescence device LIGHTVISION®. This device has several promising features, including the fact that there is no need to switch off the room light, it has hands-free operability, and it can be located away from the workspace to facilitate a good field of vision. We used the L IGHTVISION® for 15 patients and detected 59 nodules (86.8%) in a total of 68 tumors in the resected specimens during surgery. The LIGHTVISION® was used to identify the hepatic segments in ten patients, and the boundaries of the segment were clearly visualized on the liver surface on fluorescent images in all patients. All tumors were resected with surgical margins. Thus, the LIGHTVISION® appears to be very useful for navigation in liver surgery. Keywords Hepatic resection · Indocyanine green · Fluorescence imaging system
Introduction
Methods
Indocyanine green (ICG) is used widely to investigate preoperative liver function. Moreover, protein-bound ICG emits light that peaks at approximately 840 nm when illuminated with near-infrared (NIR) light with a wavelength of between 750 and 810 nm [1]. Given this feature, ICG fluorescence has been introduced in hepatobiliary surgery and proven useful for locating hepatic tumors [2, 3] and evaluating hepatic segmentation [4] and the anatomy of the biliary tree [5]. The emission of NIR light from the ICG cannot be seen with the naked eye, so various fluorescence imaging systems have been developed [6]. LIGHTVISION®, which is one such fluorescence imaging system, was developed in Japan for the main purpose of identifying the position of sentinel lymph nodes during breast cancer surgery to improve postoperative outcomes. It has not yet been applied in liver surgery. We report our initial experience of ICG fluorescence applied to liver surgery with laparotomy using a LIGHTVISION®.
LIGHTVISION®
* Masaharu Tada shatano@hyo‑med.ac.jp 1
The L IGHTVISION ® (Fig. 1a) is a cart-based device developed by Shimadzu Corporation, Kyoto, Japan. The light source, a light-emitting diode (LED), emits light at a wavelength of 780 nm, and the detector is a chargecoupled device (CCD) camera that subsequently filters light with a wavelength of 850 nm. The camera arm can be extended to a length of about 180 cm (Fig. 1b), and the camera head can turn about 40° to the right and left. The fluorescence signals are sent to high-definition sensors built into the L IGHTVISION® for display on a monitor. The LIGHTVISION® can be operated with a fixed working distance of 50 to 70 cm and the camera unit of the device is ha
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