Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery.
Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery.
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DOI：
10.1007/s00464-014-3895-x
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发表时间：
2015-07
影响因子：
3.1
通讯作者：
Fingerhut, Abe
中科院分区：
文献类型：
--
作者：
Boni, Luigi;David, Giulia;Mangano, Alberto;Dionigi, Gianlorenzo;Rausei, Stefano;Spampatti, Sebastiano;Cassinotti, Elisa;Fingerhut, Abe
关键词：
最近在视频成像方面取得了重大进展：其中，高清晰度和3D成像系统的使用，以及最近的吲哚菁绿色（ICG）荧光成像正在成为外科手术过程中术中决策的主要贡献。本研究的目的是介绍我们使用ICG荧光成像进行不同腹腔镜手术的经验。 进行了108例ICG增强荧光引导的腹腔镜手术：52例腹腔镜胆囊切除术，38例结直肠切除术，8例活体供肾切除术，1例腹腔镜肾自体移植术，3例腹股沟髂/闭孔淋巴结清扫术治疗黑色素瘤，6例腹腔镜手术。通过连接到30° 10 mm内窥镜的高清立体摄像机提供结构的可视化，该内窥镜配备有特定透镜和发射可见光和近红外（NIR）光的光源（KARL STORZ GmbH & Co. KG，Tuttlingen，德国）。在注射ICG后，该系统投射出血管和器官中血流的高分辨率NIR实时图像，并突出显示胆汁排泄。未报告术中或注射相关不良反应，并且始终清楚识别胆道/血管解剖结构。该成像系统提供了宝贵的信息，以进行安全的胆囊切除术，并确保足够的血管供应，结肠切除术，肾切除术，或找到淋巴结。无胆管损伤或吻合口漏。根据我们的经验，ICG荧光成像系统似乎简单、安全且有用。鉴于其不同的诊断和肿瘤学能力，该技术很可能在不久的将来成为标准。需要进行更大规模的研究和更具体的评价，以确认其作用并解决其缺点。
Recently major developments in video imaging have been achieved: among these, the use of high definition and 3D imaging systems, and more recently indocyanine green (ICG) fluorescence imaging are emerging as major contributions to intraoperative decision making during surgical procedures. The aim of this study was to present our experience with different laparoscopic procedures using ICG fluorescence imaging. 108 ICG-enhanced fluorescence-guided laparoscopic procedures were performed: 52 laparoscopic cholecystectomies, 38 colorectal resections, 8 living-donor nephrectomies, 1 laparoscopic kidney autotransplantation, 3 inguino-iliac/obturator lymph node dissections for melanoma, and 6 miscellanea procedures. Visualization of structures was provided by a high definition stereoscopic camera connected to a 30° 10 mm scope equipped with a specific lens and light source emitting both visible and near infra-red (NIR) light (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany). After injection of ICG, the system projected high-resolution NIR real-time images of blood flow in vessels and organs as well as highlighted biliary excretion . No intraoperataive or injection-related adverse effects were reported, and the biliary/vascular anatomy was always clearly identified. The imaging system provided invaluable information to conduct a safe cholecystectomy and ensure adequate vascular supply for colectomy, nephrectomy, or find lymph nodes. There were no bile duct injuries or anastomotic leaks. In our experience, the ICG fluorescence imaging system seems to be simple, safe, and useful. The technique may well become a standard in the near future in view of its different diagnostic and oncological capabilities. Larger studies and more specific evaluations are needed to confirm its role and to address its disadvantages.
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