Dr. Takeaki Ishizawa Profile

Dr. Takeaki Ishizawa

at Univ of Tokyo

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Proceedings Article | 1 April 2020 Presentation

Applications of intraoperative fluorescence imaging to hepatobiliary and pancreatic surgery (Conference Presentation)

Takeaki Ishizawa, Yasuteru Urano, Kiyoshi Hasegawa

Proceedings Volume 11362, 113620V (2020) https://doi.org/10.1117/12.2559293

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Recently, in vivo fluorescence imaging using indocyanine green (ICG) has actively been applied to hepatobiliary and pancreatic surgery in clinical settings. 1) Fluorescence cholangiography: fluorescence images of the extrahepatic bile ducts can be obtained by intrabiliary injection of ICG solution (0.025 mg/mL) or preoperative intravenous injection of ICG (2.5 mg). The latter technique begins to be used worldwide for confirmation of the bile duct anatomy during minimally-invasive cholecystectomy. 2) Identification of hepatic tumors: Following preoperative intravenous injection of ICG (0.5 mg/kg), it can accumulate in hepatocellular carcinoma tissues and in non-cancerous hepatic parenchyma surrounding liver metastasis, enabling intraoperative identification of subcapsular hepatic tumors by fluorescence imaging. 3) Hepatic segmentation: ICG solution (0.25 mg/5 mL) is injected into a tumor-bearing portal branch under ultrasound guidance (positive staining). ICG can also be administered intravenously following closure of a corresponding portal pedicle (negative staining). These techniques enables delineation of hepatic segmental boundaries throughout surgical procedures. 4) Assessment of blood perfusion: Fluorescence imaging following intraoperative bolus injection of ICG (2.5mg) visualizes arterial/portal blood flows and perfusion in the surrounding organs during surgeries requiring resection/reconstruction of the major vessels. for intraoperative visualization of biological structures and perfusion assessment. In addition, we have developed a novel fluorophore (glutaryl-phenylalanine hydroxymethyl rhodamine green) activated by pancreatic chymotrypsin for real-time identification of pancreatic juice leakage.

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