Name: the role of indocyanine green fluorescence in complex laparoscopic cholecystectomy navigation
Uploaded: 2025-01-31T13:50:00.000+00:00
Duration: 3 min 27 s
Description: Laparoscopic cholecystectomy (LC) is the gold-standard treatment for cholelithiasis and cholecystitis. In difficult cases with severe inflammation and ...

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	<li>Lammert, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gallstones.">Gallstones.</a> Nat Rev Dis Primers. 2, 16024 (2016).</li><li>Georgiades, C. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+inflammation+a+significant+predictor+of+bile+duct+injury+during+laparoscopic+cholecystectomy.">Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy.</a> Surg Endosc. 22 (9), 1959-1964 (2008).</li><li>Flum, D. R., Cheadle, A., Prela, C., Dellinger, E. P., Chan, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bile+duct+injury+during+cholecystectomy+and+survival+in+medicare+beneficiaries.">Bile duct injury during cholecystectomy and survival in medicare beneficiaries.</a> JAMA. 290 (16), 2168-2173 (2003).</li><li>Ortenzi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+laparoscopic+cholecystectomy+performed+by+trainee+surgeons+with+different+cholangiographic+techniques+(SCOTCH):+A+prospective+non-randomized+trial+on+the+impact+of+fluorescent+cholangiography+during+laparoscopic+cholecystectomy+performed+by+trainees.">Safety of laparoscopic cholecystectomy performed by trainee surgeons with different cholangiographic techniques (SCOTCH): A prospective non-randomized trial on the impact of fluorescent cholangiography during laparoscopic cholecystectomy performed by trainees.</a> Surg Endosc. 38 (2), 1045-1058 (2024).</li><li>Araki, K., Conrad, C., Ogiso, S., Kuwano, H., Gayet, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+ultrasonography+of+laparoscopic+hepatectomy:+Key+technique+for+safe+liver+transection.">Intraoperative ultrasonography of laparoscopic hepatectomy: Key technique for safe liver transection.</a> J Am Coll Surg. 218 (2), e37-e41 (2014).</li><li>Nguyen, Q. T., Tsien, R. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fluorescence-guided+surgery+with+live+molecular+navigation-A+new+cutting+edge.">Fluorescence-guided surgery with live molecular navigation-A new cutting edge.</a> Nat Rev Cancer. 13 (9), 653-662 (2013).</li><li>Manasseh, M., Davis, H., Bowling, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluating+the+Role+of+Indocyanine+Green+Fluorescence+Imaging+in+Enhancing+Safety+and+Efficacy+During+Laparoscopic+Cholecystectomy:+A+Systematic+Review.">Evaluating the Role of Indocyanine Green Fluorescence Imaging in Enhancing Safety and Efficacy During Laparoscopic Cholecystectomy: A Systematic Review.</a> Cureus. 16 (11), e73388 (2024).</li><li>Zhou, H., He, Y., Chang, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+study+of+Indocyanine+Green+fluorescence+imaging+versus+conventional+fiber-optic+imaging+in+laparoscopic+choledochotomy+for+stone+extraction+and+immediate+biliary+incision+suturing.">Comparative study of Indocyanine Green fluorescence imaging versus conventional fiber-optic imaging in laparoscopic choledochotomy for stone extraction and immediate biliary incision suturing.</a> Updates Surg. 76 (6), 2247-2254 (2024).</li><li>Quaresima, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Routine+near+infra-red+indocyanine+green+fluorescent+cholangiography+versus+intraoperative+cholangiography+during+laparoscopic+cholecystectomy:+A+case-matched+comparison.">Routine near infra-red indocyanine green fluorescent cholangiography versus intraoperative cholangiography during laparoscopic cholecystectomy: A case-matched comparison.</a> Surg Endosc. 34 (5), 1959-1967 (2020).</li><li>Lim, S. H., Tan, H. T. A., Shelat, V. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+indocyanine+green+dye+fluorescent+cholangiography+with+intra-operative+cholangiography+in+laparoscopic+cholecystectomy:+a+meta-analysis.">Comparison of indocyanine green dye fluorescent cholangiography with intra-operative cholangiography in laparoscopic cholecystectomy: a meta-analysis.</a> Surg Endosc. 35 (4), 1511-1520 (2021).</li><li>Benya, R., Quintana, J., Brundage, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adverse+reactions+to+indocyanine+green:+a+case+report+and+a+review+of+the+literature.">Adverse reactions to indocyanine green: a case report and a review of the literature.</a> Cathet Cardiovasc Diagn. 17 (4), 231-233 (1989).</li><li>Pardo Aranda, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Indocyanine+green+(ICG)+fluorescent+cholangiography+in+laparoscopic+cholecystectomy:+Simplifying+time+and+dose.">Indocyanine green (ICG) fluorescent cholangiography in laparoscopic cholecystectomy: Simplifying time and dose.</a> Dig Liver Dis. 55 (2), 249-253 (2023).</li><li>Dip, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+fluorescence+imaging+and+indocyanine+green+during+laparoscopic+cholecystectomy:+Results+of+an+international+Delphi+survey.">Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: Results of an international Delphi survey.</a> Surgery. 172 (6S), S21-S28 (2022).</li><li>Chen, Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extrahepatic+biliary+tract+visualization+using+near-infrared+fluorescence+imaging+with+indocyanine+green:+Optimization+of+dose+and+dosing+time.">Extrahepatic biliary tract visualization using near-infrared fluorescence imaging with indocyanine green: Optimization of dose and dosing time.</a> Surg Endosc. 35 (10), 5573-5582 (2021).</li><li>Hori, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Protocol+for+laparoscopic+cholecystectomy:+Is+it+rocket+science.">Protocol for laparoscopic cholecystectomy: Is it rocket science.</a> World J Gastroenterol. 22 (47), 10287-10303 (2016).</li><li>Elshaer, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Subtotal+cholecystectomy+for+&amp;#34;difficult+gallbladders&amp;#34;:+Systematic+review+and+meta-analysis.">Subtotal cholecystectomy for &amp;#34;difficult gallbladders&amp;#34;: Systematic review and meta-analysis.</a> JAMA Surg. 150 (2), 159-168 (2015).</li><li>Fletcher, D. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+cholecystectomy:+Risks+of+the+laparoscopic+approach+and+protective+effects+of+operative+cholangiography:+A+population-based+study.">Complications of cholecystectomy: Risks of the laparoscopic approach and protective effects of operative cholangiography: A population-based study.</a> Ann Surg. 229 (4), 449-457 (1999).</li><li>Flum, D. R., Dellinger, E. P., Cheadle, A., Chan, L., Koepsell, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+cholangiography+and+risk+of+common+bile+duct+injury+during+cholecystectomy.">Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy.</a> JAMA. 289 (13), 1639-1644 (2003).</li><li>Wang, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=NIR-II+fluorescence-guided+liver+cancer+surgery+by+a+small+molecular+HDAC6+targeting+probe.">NIR-II fluorescence-guided liver cancer surgery by a small molecular HDAC6 targeting probe.</a> EBioMedicine. 98, 104880 (2023).</li><li>Hu, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=First-in-human+liver-tumour+surgery+guided+by+multispectral+fluorescence+imaging+in+the+visible+and+near-infrared-I/II+windows.">First-in-human liver-tumour surgery guided by multispectral fluorescence imaging in the visible and near-infrared-I/II windows.</a> Nat Biomed Eng. 4 (3), 259-271 (2020).</li><li>Lau, N. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+and+potential+applications+for+indocyanine+green+in+liver+transplantation.">Current and potential applications for indocyanine green in liver transplantation.</a> Transplantation. 106 (7), 1339-1350 (2022).</li><li>van den Bos, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Near-infrared+fluorescence+cholangiography+assisted+laparoscopic+cholecystectomy+(FALCON):+An+international+multicentre+randomized+controlled+trial.">Near-infrared fluorescence cholangiography assisted laparoscopic cholecystectomy (FALCON): An international multicentre randomized controlled trial.</a> Surg Endosc. 37 (6), 4574-4584 (2023).</li><li>Wang, X. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+fluorescent+cholangiography+in+preventing+biliary+tract+injury+and+finding+bile+leakage.">The role of fluorescent cholangiography in preventing biliary tract injury and finding bile leakage.</a> Zhonghua Yi Xue Za Zhi. 103 (16), 1242-1244 (2023).</li><li>Esposito, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Image-guided+pediatric+surgery+using+indocyanine+green+(ICG)+fluorescence+in+laparoscopic+and+robotic+surgery.">Image-guided pediatric surgery using indocyanine green (ICG) fluorescence in laparoscopic and robotic surgery.</a> Front Pediatr. 8, 314 (2020).</li><li>Cardenas, G., Fornaguera, I., Diaz Del Gobbo, R., Ginesta, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Direct+gallbladder+indocyanine+green+injection+technique+to+achieve+critical+view+of+safety+in+laparoscopic+cholecystectomy.">Direct gallbladder indocyanine green injection technique to achieve critical view of safety in laparoscopic cholecystectomy.</a> Cir Esp (Engl Ed). 99 (9), 678-682 (2021).</li><li>Castagneto-Gissey, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracholecystic+versus+intravenous+indocyanine+green+(ICG)+injection+for+biliary+anatomy+evaluation+by+fluorescent+cholangiography+during+laparoscopic+cholecystectomy:+a+case-control+study.">Intracholecystic versus intravenous indocyanine green (ICG) injection for biliary anatomy evaluation by fluorescent cholangiography during laparoscopic cholecystectomy: a case-control study.</a> J Clin Med. 11 (12), 3508 (2022).</li><li>Esposito, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Indocyanine+green+(ICG)+fluorescent+cholangiography+during+laparoscopic+cholecystectomy+using+RUBINA+technology:+Preliminary+experience+in+two+pediatric+surgery+centers.">Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA technology: Preliminary experience in two pediatric surgery centers.</a> Surg Endosc. 35 (11), 6366-6373 (2021).</li><li>Liu, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Investigation+of+the+optimal+indocyanine+green+dose+in+real-time+fluorescent+cholangiography+during+laparoscopic+cholecystectomy+with+an+ultra-high-definition+4K+fluorescent+system:+A+randomized+controlled+trial.">Investigation of the optimal indocyanine green dose in real-time fluorescent cholangiography during laparoscopic cholecystectomy with an ultra-high-definition 4K fluorescent system: A randomized controlled trial.</a> Updates Surg. 75 (7), 1903-1910 (2023).</li><li>Huang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+fluorescent+cholangiography+with+indocyanine+green+in+laparoscopic+cholecystectomy:+a+randomized+controlled+trial+to+establish+the+optimal+indocyanine+green+dose+within+30+min+preoperatively.">Real-time fluorescent cholangiography with indocyanine green in laparoscopic cholecystectomy: a randomized controlled trial to establish the optimal indocyanine green dose within 30 min preoperatively.</a> Surg Today. 53 (2), 223-231 (2023).</li><li>Lopez-Sanchez, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dose+and+administration+time+of+indocyanine+green+in+near-infrared+fluorescence+cholangiography+during+laparoscopic+cholecystectomy+(DOTIG):+Study+protocol+for+a+randomised+clinical+trial.">Dose and administration time of indocyanine green in near-infrared fluorescence cholangiography during laparoscopic cholecystectomy (DOTIG): Study protocol for a randomised clinical trial.</a> BMJ Open. 13 (3), e067794 (2023).</li><li>Esposito, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+application+and+technical+standardization+of+indocyanine+green+(ICG)+fluorescence+imaging+in+pediatric+minimally+invasive+surgery.">Clinical application and technical standardization of indocyanine green (ICG) fluorescence imaging in pediatric minimally invasive surgery.</a> Pediatr Surg Int. 35 (10), 1043-1050 (2019).</li></ol>

<table><tbody><tr><td>3-0 MERSILK</td><td>JOHNSON MEDICAL (CHINA) LTD.&amp;nbsp;</td><td>SA84G</td><td>The Suture Material</td></tr><tr><td>4-0 Coated VICRYL</td><td>ETHICON</td><td>VCP310</td><td>The Suture Material</td></tr><tr><td>Endoscopic Fluorescence Imaging System</td><td>ZHUHAI DI PU MEDICAL TECHNOLOGY CO., LTD.&amp;nbsp;</td><td>H380022041YF</td><td>Fluorescence Laparoscope Equipment</td></tr><tr><td>Hem-O-lock Clips</td><td>SINOLINKS MEDICAL INNOVOATION, INC.</td><td>B240714</td><td>Hem-O-lock Clips</td></tr><tr><td>Indocyanine Green for Injection</td><td>DANDONG YICHUANG PHARMACEUTICAL CO., LTD.&amp;nbsp;</td><td>H20055881</td><td>Fluorescence Dye</td></tr></tbody></table>

the role of indocyanine green fluorescence in complex laparoscopic cholecystectomy navigation

Kompleks Laparoskopik Kolesistektomi Navigasyonunda İndosiyanin Yeşili Floresansın Rolü

Laparoscopic cholecystectomy (LC) is the gold-standard treatment for cholelithiasis and cholecystitis. In difficult cases with severe inflammation and ...

the-role-indocyanine-green-fluorescence-complex-laparoscopic

Research

JoVE Journal

Medicine

The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation

256 Görüntüleme.  The Fifth Affiliated Hospital of Sun Yat-sen University. Bu protokol, floresan kılavuzluğunda laparoskopik kolesistektomi adımlarını ana hatlarıyla belirtir ve çeşitli cerrahi senaryolarda floresan navigasyonunun rolünü açıklar.

Video: Kompleks Laparoskopik Kolesistektomi Navigasyonunda İndosiyanin Yeşili Floresansın Rolü

Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical excision of the tumor with a full lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated with increased morbidity due to infection, wound breakdown and lymphedema.4,5 As an alternative, the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first draining lymph node from the tumor.6 In case of lymphogenic dissemination, the SLN is the first lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of the vulva and cervix.7 The current standard methodology for SLN-detection is by peritumoral injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to increased psychological distress for the patient, and the use of radioactive colloid.
Multispectral fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess cardiac function, cerebral perfusion and liver perfusion.8 It is an inert drug with a safe pharmaco-biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around 800 nm. A custom-made multispectral fluorescence imaging camera system was used.9.
The aim of this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging might replace the current method and is also easily transferable to other indications like breast cancer and melanoma.

Fluorescence imaging is a promising innovative modality for image-guided surgery in surgical oncology. In this video we describe the technical procedure for detection of the sentinel lymph node using fluorescence imaging as showcased in gynecologic oncologicy. A multispectral fluorescence camera system, together with the fluorescent agent indocyanine green, is applied.

Jinekolojik Onkoloji Sentinel lenf nodu intraoperatif Algılama için Multispektral Gerçek zamanlı Floresans Görüntüleme

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical ...

Tıp

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio based cues and set within the context of a video game metaphor, users gather relevant spatial information regarding a building's layout. This allows the user to develop an accurate spatial cognitive map of a large-scale three-dimensional space that can be manipulated for the purposes of a real indoor navigation task. After game play, participants are then assessed on their ability to navigate within the target physical building represented in the game. Preliminary results suggest that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building as indexed by their performance on a series of navigation tasks. These tasks included path finding through the virtual and physical building, as well as a series of drop off tasks. We find that the immersive and highly interactive nature of the AbES software appears to greatly engage the blind user to actively explore the virtual environment. Applications of this approach may extend to larger populations of visually impaired individuals.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind.

Ses tabanlı Sanal Oyun Ortamı Geliştirilmesi Kör Navigasyon Becerileri ile Yrd etmek

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during totally laparoscopic gastrectomy (TLG). The aim of this protocol is to introduce a procedure for intraoperative gastroscopy, in order to directly mark tumors during TLG for gastric cancer in the middle third of the stomach. Patients who were diagnosed with adenocarcinoma in the middle third of the stomach were enrolled in this case series. Before surgery, additional gastroscopy for tumor localization is not performed. Under general anesthesia, laparoscopic mobilization of the stomach is performed first. After the first portion of the duodenum is mobilized from the pancreas and clamped, the surgeon moves to the other side for the gastroscopic procedure. On the insertion of a gastroscope through the oral cavity into the stomach, 2 - 3 cc of indigo carmine is administered via an endoscopic injector into the gastric muscle layer at the proximal margin of the stomach. The location of stained serosa in the laparoscopic view is used to guide distal subtotal gastrectomy, however, total gastrectomy is performed if the tumor is too close to the esophagogastric junction. A specimen is sampled after distal gastrectomy to confirm sufficient length from resection margin to tumor before reconstruction. In our case series, all patients had tumor-free margins and required no additional resection. There was no morbidity related to the gastroscopic procedure, and the time required for the procedure has gradually decreased to about five minutes. Intraoperative gastroscopy for tumor localization is an accurate and tolerated method for gastric cancer patients undergoing totally laparoscopic distal gastrectomy.

In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

Mide Adenokarsinomu için Laparoskopik Cerrahi Tümör lokalizasyonu İntraoperatif Gastroskopi

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during ...

Indocyanine Green-Guided Intraoperative Imaging to Facilitate Video-Assisted Retroperitoneal Debridement for Treating Acute Necrotizing Pancreatitis

Video-assisted retroperitoneal debridement (VARD) is a feasible, minimally invasive necrosectomy method for treating severe acute necrotizing pancreatitis, if it does not resolve or is accompanied with infected necrosis in the retroperitoneum. As there are rarely any visually clear separating surface in white light image between necrotic debris and adjacent inflammatory normal tissues due to extensive retroperitoneal adhesions, VARD is accompanied with the risk of vascular injury, external pancreatico-cutaneous or enterocutaneous fistulae. In view of the above disadvantages, we apply real-time intraoperative near-infrared fluorescence imaging with indocyanine green (ICG) during VARD, which enables visualization of the well-perfused adjacent normal tissues. This modified technique (ICG-guided VARD) can provide a clear separating surface during debridement and reduce the risk of vascular or enteric injury. ICG-guided VARD may facilitate surgeons to perform safer debridement in treating severe acute necrotizing pancreatitis.

This protocol presents Indocyanine Green-guided video-assisted retroperitoneal debridement (ICG-guided VARD) for treating severe acute necrotizing pancreatitis.

Akut Nekrotizan Pankreatit Tedavisinde Video Yardımlı Retroperitoneal Debridmanı Kolaylaştırmak için İndosiyanin Yeşil Kılavuzlu İntraoperatif Görüntüleme

Video-assisted retroperitoneal debridement (VARD) is a feasible, minimally invasive necrosectomy method for treating severe acute necrotizing ...

Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst

Biliary cysts (BC) are rare congenital dilatations of intra- and extrahepatic parts of the biliary tract and bear a significant risk of carcinogenesis. Surgery is the cornerstone treatment for patients with BC. While total BC excision and Roux-Y hepaticojejunostomy is the treatment method of the choice in patients with extrahepatic BC (i.e., Todani I-IV), patients with intrahepatic BC (i.e., Todani V) benefit the most from a surgical liver resection. In recent years, minimally invasive liver surgery (MILS) including robotic MILS has gained more acceptance as a feasible, safe, and effective procedure for the treatment of both benign and malignant indications. Robotic major MILS is still considered technically demanding and a detailed description of the technical approach during robotic major MILS has only been limitedly discussed in the literature. The current article describes the main steps for a robotic left hepatectomy in a patient with a large BC Todani Type V. The patient is in French position with 5 trocars placed (4 robotic, 1 laparoscopic assistant). After mobilizing the left hemiliver, the left and right hepatic artery are dissected carefully followed by a cholecystectomy. Intraoperative ultrasound is performed to confirm localization and margins of the BC. The Left hepatic artery and left portal vein are isolated, clipped, and divided. Indocyanine green (ICG) fluorescence imaging is used regularly during the entire procedure to visualize and confirm biliary tract anatomy and the BC. Parenchymal transection is performed with robotic cautery hook for the superficial part and robotic cautery spatula, bipolar cautery, and vessel sealer for the deeper parenchyma. The postoperative course was uncomplicated. A robotic left hepatectomy is technically demanding, yet a feasible and safe procedure. ICG-fluorescence imaging aids in delineating the BC and bile duct anatomy. Further, comparative studies are needed to confirm clinical benefits of robotic MILS for benign and malignant indications.

Robotic liver surgery has gained more acceptance as a feasible, safe, and effective procedure for the treatment of both benign and malignant indications. However, robotic left hepatectomy is still technically demanding. We describe our surgical technique of a robotic left hepatectomy using indocyanine green fluorescence imaging for a large biliary cyst.

İntrahepatik Kompleks Biliyer Kist için İndosiyanin Yeşil Floresan Görüntüleme Kullanılarak Robotik Sol Hepatektomi

Biliary cysts (BC) are rare congenital dilatations of intra- and extrahepatic parts of the biliary tract and bear a significant risk of carcinogenesis. ...

Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ultrasound, important vascular structures, and surgeon experience. With the development of anatomical hepatectomy, visual surgery technology has gradually been applied to this type of surgery, particularly indocyanine green (ICG)-guided anatomical hepatectomy. As ICG can be specifically ingested by hepatocytes and used for fluorescence tracing, negative staining techniques have been applied according to different tumor positions. Under ICG fluorescent guidance, the surface boundary and deep resection plane can be more accurately displayed during liver resection. Thus, the tumor-bearing liver segment can be anatomically removed, which helps to avoid damage to important vessels and reduce ischemia or congestion of the remaining liver tissue. Finally, the incidence of postoperative biliary fistula and liver dysfunction is reduced; therefore, a better prognosis is obtained after the resection of liver cancer. Centrally located liver cancer is usually defined as a tumor located at segments 4, 5, or 8 that requires resection of the middle section of the liver. These are among the most difficult hepatectomies to perform because of the large surgical wounds and multiple vessel transections. Based on the specific tumor location, we formulated the required resection ranges by designing personalized fluorescent staining strategies. By completing anatomical resection based on the portal territory, this work aims to achieve the best therapeutic effect.

The present protocol describes fluorescent negative staining in laparoscopic central hepatectomy. This technique can make hepatectomy more accurate and precise.

İndosiyanin Yeşili Negatif Boyama Kullanılarak Karaciğer Kanseri için Floresan Laparoskopik Santral Hepatektomi

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ...

Farede Lazer ile İndüklenen CNV'nin Farklı Lezyon Tiplerinin Karakterizasyonu

Characterization of Vascular Morphology of Neovascular Age-Related Macular Degeneration by Indocyanine Green Angiography

Age-related macular degeneration (AMD) is a leading cause of blindness among older individuals, and its prevalence is rapidly increasing due to the aging population. Choroidal neovascularization (CNV) or wet AMD, which accounts for 10%-20% of all AMD cases, is responsible for an alarming 80%-90% of AMD-related blindness. Current anti-VEGF therapies show suboptimal responses in approximately 50% of patients. Resistance to anti-VEGF treatment in CNV patients is often associated with arteriolar CNV, while responders tend to have capillary CNV. While fluorescein angiography (FA) is commonly used to assess leakage patterns in wet AMD patients and animal models, it does not provide information about CNV vascular morphology (arteriolar CNV vs. capillary CNV). This protocol introduces the use of indocyanine green angiography (ICGA) to characterize lesion types in laser-induced CNV mouse models. This method is crucial for investigating the mechanisms and treatment strategies for anti-VEGF resistance in wet AMD. It is recommended to incorporate ICGA alongside FA for comprehensive assessment of both leakage and vascular features of CNV in mechanistic and therapeutic studies.

Yazar Spotlight: Koroidal Neovaskülarizasyonda İleri Vasküler Morfoloji Değerlendirmesi Yoluyla Anti-VEGF Direncinin Üstesinden Gelmek

Currently, fluorescein angiography (FA) is the preferred method for identifying leakage patterns in animal models of choroidal neovascularization (CNV). However, FA does not provide information about vascular morphology. This protocol outlines the use of indocyanine green angiography (ICGA) to characterize different lesion types of laser-induced CNV in mouse models.

Neovasküler Yaşa Bağlı Makula Dejenerasyonunun Vasküler Morfolojisinin İndosiyanin Yeşili Anjiyografi ile Karakterizasyonu

Age-related macular degeneration (AMD) is a leading cause of blindness among older individuals, and its prevalence is rapidly increasing due to the aging ...

Laparoscopic Duodenum-Preserving Pancreatic Head Resection via Inferior Infracolic Approach: A Surgical Approach for Benign Lesions

Minimally invasive pancreatic resections are gaining popularity despite being technically demanding. However, in contrast to laparoscopic pancreatoduodenectomy (LPD), laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) has not yet obtained wide acceptance. This could be attributed to the technical challenges involved in preserving the blood supply of the duodenum and bile duct.
This study describes and demonstrates all the steps of LDPPHR. A 48-year-old woman was diagnosed with a 3.0 cm x 2.5 cm pancreatic head cystic mass, which was detected unexpectedly. The surgery was performed using the 3D laparoscopy via an inferior infracolic approach. The operation lasted approximately 310 min with 100 mL of blood loss. Postoperatively, the patient experienced no complications and was discharged 5 days later. Pathology revealed intraductal papillary mucinous neoplasms.
LDPPHR via an inferior infracolic approach is feasible and safe when performed by experienced surgeons in selected patients with thin mesenteric fat layers. The described technique for LDPPHR via inferior infracolic approach should be well standardized and performed at high-volume centers with experienced surgeons in both open and laparoscopic pancreatology.

This article provides a whole technical process of laparoscopic duodenum-preserving pancreatic head resection via an inferior infracolic approach. This is a surgical approach for benign tumors without intraoperative fluorescence image guidance.

Kompleks Laparoskopik Kolesistektomi Navigasyonunda İndosiyanin Yeşili Floresansın Rolü

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