Recent fluorescence imaging technology applications of indocyanine green in general thoracic surgery
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REVIEW ARTICLE
Recent fluorescence imaging technology applications of indocyanine green in general thoracic surgery Yosuke Matsuura1 · Junji Ichinose1 · Masayuki Nakao1 · Sakae Okumura1 · Mingyon Mun1 Received: 1 July 2019 / Accepted: 20 September 2019 © Springer Nature Singapore Pte Ltd. 2019
Abstract Thoracic surgeons perform a wide variety of cancer operations, which are often associated with high morbidity and mortality. Thus, thoracic surgery involves many special challenges that require innovative solutions. The increased utilization of minimally invasive practices, poor overall cancer survival, and significant morbidity of critical operations remain key obstacles to overcome. Fluorescence imaging technology (FIT), involving the implementation of fluorescent dyes and imaging systems, is currently used as an adjunct for general thoracic surgery in many situations and includes sentinel lymph node mapping, pulmonary intersegmental plane identification, pulmonary nodule identification, pulmonary bullous lesion detection, evaluation of the anastomotic perfusion after tracheal surgery, and thoracic duct imaging for postoperative chylothorax. This technology enhances the surgeon’s ability to perform operations, and has specific advantages. We review some of the key studies that demonstrate the applications of FIT in the field of general thoracic surgery, focusing on the use of indocyanine green. Keywords Fluorescence imaging technology · Near-infrared fluorescence imaging · Indocyanine green · General thoracic surgery
Introduction Fluorescence imaging technology (FIT) involves the utilization of a fluorescence-emitting contrast agent in combination with an imaging system. Therefore, FIT requires a fluorescent dye that will accumulate selectively in target tissues and a specialized imaging system to detect and quantify the dye. This technology enhances the surgeon’s ability to perform operations and its use has various advantages. First, it decreases the surgeon’s exposure to the radiation dosage. Second, FIT images allow for easy interpretation, even by surgeons who are unfamiliar with the technology. Third, FIT causes minimal interruption and integrates well into the normal flow of an operation. In general thoracic surgery, FIT has advanced remarkably. It is used for sentinel lymph node (SLN) mapping, pulmonary intersegmental plane identification, pulmonary nodule identification, pulmonary bullous lesion detection, * Yosuke Matsuura [email protected] 1
Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3‑8‑31, Ariake, Koto‑ku, Tokyo 135‑8550, Japan
evaluation of the anastomotic perfusion after tracheal surgery, and thoracic duct imaging for postoperative chylothorax [1]. In this review, we summarize the current FIT applications in the field of general thoracic surgery, focusing on the use of indocyanine green (ICG).
Fluorescent dyes for FIT To date, four fluorescent dyes have been used in clinical practice and clinical trials in the
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