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Peul RC, Kharbanda RK, Koning S, Kruiswijk MW, Tange FP, van den Hoven P, Vahrmeijer AL, Klautz RJ, Hamming JF, Hjortnaes J, van der Vorst JR. Intraoperative assessment of myocardial perfusion using near-infrared fluorescence and indocyanine green: A literature review. JTCVS Tech 2025; 30:81-93. [PMID: 40242100 PMCID: PMC11998401 DOI: 10.1016/j.xjtc.2025.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 12/05/2024] [Accepted: 12/20/2024] [Indexed: 04/18/2025] Open
Abstract
Background Coronary artery bypass grafting (CABG) is among the most commonly performed major surgical procedures worldwide. While flow measurements help assess graft patency during surgery, there are limited tools available for surgeons to objectively evaluate myocardial perfusion after graft placement. Near-infrared fluorescence (NIRF) imaging shows promise in this area, offering real-time visualization of flow and perfusion without the need for radiation or nephrotoxic contrast agents. This review summarizes current knowledge of and developments in myocardial perfusion assessment via NIRF imaging, emphasizing the potential benefits of adding quantification to enhance this technique. Methods PubMed was searched for articles describing the use of NIRF imaging for myocardial perfusion assessment. Articles were subsequently analyzed based on study objectives, subjects, and quantification capabilities. Limitations, future directions, and comparisons with other techniques were examined to recognize patterns and describe the chronological developments in NIRF imaging for myocardial perfusion assessment. Results Twenty-eight articles were included, 11 of which explored quantification. Only 5 of these articles included patients. Aims and techniques varied significantly among studies. Compared to the abundance of qualitative assessments, quantified NIRF imaging in patients remains limited. Conclusions This literature review highlights that NIRF imaging has been broadly researched qualitatively, showing promise for guiding CABG surgery through visualization of graft flow. However, the critical step of incorporating quantification to accurately assess myocardial perfusion remains insufficiently explored. To optimize decision making during CABG surgery, future studies must focus on intraoperative application of quantified NIRF imaging in cardiovascular patients.
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Affiliation(s)
- Roderick C. Peul
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rohit K. Kharbanda
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefan Koning
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Mo W. Kruiswijk
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Floris P. Tange
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Pim van den Hoven
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Robert J.M. Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam-Zuidoost, The Netherlands
| | - Jaap F. Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jesper Hjortnaes
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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2
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Dhua AK, Jain V, Yadav DK, Goel P, Agarwala S. Harnessing Indocyanine Green Fluorescence for Checking Intraoperative Patency of Splenorenal Shunt for Extrahepatic Portal Venous Obstruction. J Indian Assoc Pediatr Surg 2025; 30:257-259. [PMID: 40191501 PMCID: PMC11968054 DOI: 10.4103/jiaps.jiaps_232_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Revised: 11/18/2024] [Accepted: 12/09/2024] [Indexed: 04/09/2025] Open
Abstract
This case report discusses intraoperative indocyanine green (ICG) fluorescence angiography to confirm the patency of a proximal splenorenal shunt in an 11-year-old patient with extrahepatic portal venous obstruction. The patient, managed previously with endoscopic sclerotherapy and propranolol, experienced recurrent gastrointestinal bleeding, necessitating surgical intervention. A proximal splenorenal shunt was created following splenectomy, and portal pressures dropped significantly from 33 to 14 mmHg postshunt creation. ICG was injected intraoperatively to assess shunt patency, and fluorescence imaging using the Olympus VISERA ELITE III system confirmed proper blood flow through the shunt. This technique and portal pressure measurements validated the patency without using Doppler ultrasound. ICG angiography offers a reliable alternative for intraoperative vascular assessment, expanding its application in pediatric surgery. This report underscores the novelty of using ICG in pediatric shunt surgeries and its potential in various shunt procedures.
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Affiliation(s)
| | - Vishesh Jain
- Department of Pediatric Surgery, AIIMS, Delhi, India
| | | | - Prabudh Goel
- Department of Pediatric Surgery, AIIMS, Delhi, India
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Di Giammarco G, Cammertoni F, Testa N, Massetti M. Understanding Surgeons' Reluctance to Adopt Intraoperative Coronary Graft Verification Procedures: A Literature Review Combined to AI-Driven Insights Under Human Supervision. J Clin Med 2024; 13:6889. [PMID: 39598033 PMCID: PMC11595088 DOI: 10.3390/jcm13226889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 11/10/2024] [Accepted: 11/12/2024] [Indexed: 11/29/2024] Open
Abstract
Background: Intraoperative graft verification in coronary surgery is accepted worldwidand equally discussed. In spite of multiple sources of evidence published up to now in favor of clinical benefits following the use of the procedure, there is a persistent skepticism in adopting the available technologies. The object of the present review is to analyze the reluctance of surgeons toward the adoption of assessment methods. Materials and Method: A thorough literature review was carried out on Google Scholar based on the results obtained from AI's answer to the question about the reasons for that reluctance. We took advantage of using ChatGPT-4 since the research based on PubMed Central alone was not able to return a detailed response, maybe because the reasons for the reluctance are veiled in the text of the published papers. Through the items suggested by AI and taken from the literature, we deepened the research, pointing attention to the issues published so far about the various technologies. Results: There are many convincing pieces of evidence about the utility of intraoperative graft control in coronary surgery, involving improved clinical outcome, efficacy and safety, and social cost saving. The opinion that arose through this analysis is that, beyond the objective difficulties in utilizing some technologies and the equally objective limitations of an economic and organizational nature, the reluctance is the result of a real unwillingness based on the various implications that the discovery of the technical error entails. Conclusions: This negative attitude, in light of the convincing scientific and clinical evidence published up to now, appears to overwhelm the benefits for patients.
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Affiliation(s)
- Gabriele Di Giammarco
- Department of Neuroscience, Imaging and Clinical Science, School of Medicine and Health Science, Università “G.D’Annunzio” Chieti–Pescara, 66100 Chieti, Italy
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy;
| | - Federico Cammertoni
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.C.); (N.T.)
| | - Nicola Testa
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.C.); (N.T.)
| | - Massimo Massetti
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy;
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.C.); (N.T.)
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4
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Abdelrahman H, El-Menyar A, Peralta R, Al-Thani H. Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients. World J Gastrointest Surg 2023; 15:757-775. [PMID: 37342859 PMCID: PMC10277941 DOI: 10.4240/wjgs.v15.i5.757] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/18/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
Background: Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging. Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries. Bowel anastomosis after trauma-related resection is associated with a high rate of leakage. The ability of the surgeon’s bare eye to determine bowel viability remains limited, and the need for a more standardized objective assessment has not yet been fulfilled. Hence, there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize trauma-associated complications. Indocyanine green (ICG) coupled with fluorescence angiography is a potential solution for this problem. ICG is a fluorescent dye that responds to near-infrared irradiation. Methods: We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery. Discussion: ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance. However, there is a paucity of information regarding the use of this technology to treat traumas. Recently, angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions, leading to fewer cases of anastomotic insufficiency. This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety. However, there is no consensus on the ideal dose, time, and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings. Conclusions: There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection. This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients’ operative care and safety in the field of trauma surgery.
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Affiliation(s)
| | - Ayman El-Menyar
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Ruben Peralta
- Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Hassan Al-Thani
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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5
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Ishizawa T, McCulloch P, Muehrcke D, Carus T, Wiesel O, Dapri G, Schneider-Koriath S, Wexner SD, Abu-Gazala M, Boni L, Cassinotti E, Sabbagh C, Cahill R, Ris F, Carvello M, Spinelli A, Vibert E, Terasawa M, Takao M, Hasegawa K, Schols RM, Pruimboom T, Murai Y, Matano F, Bouvet M, Diana M, Kokudo N, Dip F, White K, Rosenthal RJ. Assessing the development status of intraoperative fluorescence imaging for perfusion assessments, using the IDEAL framework. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2021; 3:e000088. [PMID: 35047805 PMCID: PMC8749280 DOI: 10.1136/bmjsit-2021-000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives Intraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: assessing tissue perfusion; identifying/localizing cancer; mapping lymphatic systems; and visualizing anatomy. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging for perfusion assessments using the Idea, Development, Exploration, Assessment, Long Term Study (IDEAL) framework, which was designed for describing the stages of innovation in surgery and other interventional procedures. Design Narrative literature review with analysis of IDEAL stage of each field of study. Setting All publications on intraoperative fluorescence imaging for perfusion assessments reported in PubMed through 2019 were identified for six surgical procedures: coronary artery bypass grafting (CABG), upper gastrointestinal (GI) surgery, colorectal surgery, solid organ transplantation, reconstructive surgery, and cerebral aneurysm surgery. Main outcome measures The IDEAL stage of research evidence was determined for each specialty field using a previously described approach. Results 196 articles (15 003 cases) were selected for analysis. Current status of research evidence was determined to be IDEAL Stage 2a for upper GI and transplantation surgery, IDEAL 2b for CABG, colorectal and cerebral aneurysm surgery, and IDEAL Stage 3 for reconstructive surgery. Using the technique resulted in a high (up to 50%) rate of revisions among surgical procedures, but its efficacy improving postoperative outcomes has not yet been demonstrated by randomized controlled trials in any discipline. Only one possible adverse reaction to intravenous indocyanine green was reported. Conclusions Using fluorescence imaging intraoperatively to assess perfusion is feasible and appears useful for surgical decision making across a range of disciplines. Identifying the IDEAL stage of current research knowledge aids in planning further studies to establish the potential for patient benefit.
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Affiliation(s)
- Takeaki Ishizawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Peter McCulloch
- IDEAL Collaboration, Nuffield Department of Surgical Science, University of Oxford, John Radcliffe Hospital, Oxford, Oxfordshire, UK
| | | | | | - Ory Wiesel
- Maimonides Medical Center, Brooklyn, New York, USA
- Rabin Medical Center, Petah Tikva, Israel
| | - Giovanni Dapri
- Saint-Pierre University Hospital, Bruxelles, Bruxelles, Belgium
| | | | | | - Mahmoud Abu-Gazala
- General Surgery Department, Hadassah Medical Center Hebrew University Biotechnology Park, Jerusalem, Jerusalem, Israel
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens, Hauts-de-France, France
- Simplication of Surgical Pateint Care Research Unit, University of Picardie Jules Verne, Amiens, France
| | - Ronan Cahill
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Frederic Ris
- Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
| | - Eric Vibert
- Centre Hépato-Biliaire, Hopital Universitaire Paul Brousse, Villejuif, France
| | - Muga Terasawa
- Centre Hépato-Biliaire, Hopital Universitaire Paul Brousse, Villejuif, France
| | - Mikiya Takao
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Rutger M Schols
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands
| | - Tim Pruimboom
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Michael Bouvet
- University of California San Diego, La Jolla, California, USA
| | - Michele Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France
| | - Norihiro Kokudo
- National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Fernando Dip
- Cleveland Clinic Florida, Weston, Florida, USA
- Hospital de Clinicas Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina
| | - Kevin White
- Science Right Research Consulting London, Ontario, Canada
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Yamamoto M, Ninomiya H, Handa T, Kidawawa K, Inoue K, Sato T, Hanazaki K, Orihashi K. The impact of the quantitative assessment procedure for coronary artery bypass graft evaluations using high-resolution near-infrared fluorescence angiography. Surg Today 2021; 52:485-493. [PMID: 34415437 DOI: 10.1007/s00595-021-02357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Near-infrared angiography (NIR) is used for on-site graft assessment during coronary artery bypass grafting. This study evaluated the results of a quantitative NIR assessment using a new high-resolution NIR device (h-NIR) for graft assessment. METHODS Forty-three patients were enrolled in our study. Internal thoracic artery (ITA) grafts anastomosed to the left anterior descending artery and examined intraoperatively using h-NIR were included. The ITA grafts were divided into 2 groups for a comparative analysis: patent grafts (P group; n = 37) and failed grafts (F group; n = 6). The graft flow was evaluated by a "quantitative NIR assessment", and the fluorescence luminance intensity (FLI) was measured. Direct observation of the graft and anastomosis with h-NIR was also performed. RESULTS The FLI was higher in the P group than in the F group. The receiver operating characteristic analysis revealed the following cut-off values for FLIs depending on imaging duration: 21.1% at 1 s, 35.5% at 2 s, 58.4% at 3 s, and 83.3% at 4 s. The sensitivity and specificity for detecting graft failure were 83.3% and 69.8-80.6%, respectively. Furthermore, h-NIR was also able to visualize arterial dissection in ITA grafts. CONCLUSIONS A quantitative NIR assessment with an h-NIR device can improve the detectability of anastomotic stenosis, and h-NIR successfully detected arterial dissection of grafts.
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Affiliation(s)
- Masaki Yamamoto
- Department of Surgery, Kidawara Hospital, Nakamura Ichijoh-dohri 3-3-25, Shimanto City, Kochi, 787-0025, Japan. .,Department of Surgery 2, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan. .,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.
| | - Hitoshi Ninomiya
- Department of Civil and Environmental Engineering, Toyo University, Kawagoe City, Saitama, 350-8585, Japan
| | - Takemi Handa
- Department of Surgery 2, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Koichi Kidawawa
- Department of Surgery, Kidawara Hospital, Nakamura Ichijoh-dohri 3-3-25, Shimanto City, Kochi, 787-0025, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Department of Urology, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Department of Cardiovascular Control, Kochi Medical School,Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Kazuhiro Hanazaki
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Department of Surgery 1, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Kazumasa Orihashi
- Department of Surgery 2, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
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Mashalchi S, Pahlavan S, Hejazi M. A novel fluorescent cardiac imaging system for preclinical intraoperative angiography. BMC Med Imaging 2021; 21:37. [PMID: 33632145 PMCID: PMC7905866 DOI: 10.1186/s12880-021-00562-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/08/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Intraoperative coronary angiography can tremendously reduce early coronary bypass graft failures. Fluorescent cardiac imaging provides an advanced method for intraoperative observation and real-time quantitation of blood flow with high resolution. METHODS We devised a system comprised of an LED light source, special filters, lenses and a detector for preclinical coronary artery angiography. The optical setup was implemented by using two achromatic doublet lenses, two positive meniscus lenses, a band-pass filter, a pinhole and a CCD sensor. The setup was optimized by Zemax software. Optical design was further challenged to obtain more parallel light beams, less diffusion and higher resolutions to levels as small as arterioles. Ex vivo rat hearts were prepared and coronary arteries were retrogradely perfused by indocyanine green (ICG). Video angiography was employed to assess blood flow and plot time-dependent fluorescence intensity curve (TIC). Quantitation of blood flow was performed by calculating either the gradient of TIC or area under curve. The correlation between blood flow and each calculated parameters was assessed and used to evaluate the quality of flow. RESULTS High-resolution images of flow in coronary arteries were obtained as precise as 62 µm vessel diameter, by our custom-made ICG angiography system. The gradient of TIC was 3.4-6.3 s-1, while the area under curve indicated 712-1282 s values which ultimately gained correlation coefficients of 0.9938 and 0.9951 with relative blood flow, respectively. CONCLUSION The present ICG angiography system may facilitate evaluation of blood flow in animal studies of myocardial infarction and coronary artery grafts intraoperatively.
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Affiliation(s)
- Sara Mashalchi
- Medical Physics and Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, 1417613151, Tehran, Iran
| | - Sara Pahlavan
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Banihashem St., Resalat Highway, P.O. Box: 16635-148, 1665659911, Tehran, Iran.
| | - Marjaneh Hejazi
- Medical Physics and Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, 1417613151, Tehran, Iran. .,Research Center for Molecular and Cellular Imaging, Bio-Optical Imaging Group, Tehran University of Medical Sciences, Tehran, Iran.
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Namikawa T, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Nakayama T, Inoue K, Sato T, Kobayashi M, Hanazaki K. Evolution of photodynamic medicine based on fluorescence image-guided diagnosis using indocyanine green and 5-aminolevulinic acid. Surg Today 2020; 50:821-831. [PMID: 31346808 DOI: 10.1007/s00595-019-01851-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/21/2019] [Indexed: 02/05/2023]
Abstract
New diagnostic techniques based on photodynamic medicine, such as near-infrared fluorescence using indocyanine green (NIR-ICG) and 5-aminolevulinic acid-mediated photodynamic diagnosis (ALA-PDD), are aiding navigation tasks across various fields of surgery. Specifically, NIR-ICG is being used for the intraoperative identification of sentinel lymph nodes or blood vessels in organ resection and for blood flow evaluation in surgery. These ICG-fluorescent imaging techniques could provide an additional and potentially valuable way to identify vascular and lymphatic structures in surrounding tissue. 5-Aminolevulinic acid is a precursor of a photosensitizing substance with affinity for tumors; thus, diagnostic laparoscopy using ALA-PDD in combination should improve the accuracy of detecting peritoneal dissemination in patients with advanced gastric cancer. The ability to overlay fluorescent imaging with conventional color images in real time using ALA-PDD and NIR with ICG would be of immense benefit to surgeons, providing good visualization and detection of target lesions not seen with the naked eye. A multi-center clinical study examining the safety and efficacy of ALA-PDD during laparoscopic examination for patients with advanced gastric cancer is currently underway in the form of doctor-initiated trials, and further verification studies will be conducted. Such imaging capability could have broad potential across cancer and vascular surgery.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan.
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan.
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Taku Nakayama
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
- Department of Urology, Kochi Medical School, Kochi, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
- Department of Cardiovascular Control, Kochi Medical School, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
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9
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Clinical study of video-assisted thoracoscopic surgery wedge resection in early-stage lung cancer by tumor mapping with indocyanine green. Wideochir Inne Tech Maloinwazyjne 2019; 14:545-550. [PMID: 31908701 PMCID: PMC6939215 DOI: 10.5114/wiitm.2019.89986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 10/14/2019] [Indexed: 11/30/2022] Open
Abstract
Aim This study aimed to assess the clinical effectiveness of video-assisted thoracoscopic surgery (VATS) in early-stage lung cancer by indocyanine green (ICG) for tumor mapping. Material and methods Thirty patients with early-stage lung cancer with peripheral nodules smaller than 2 cm scheduled for computed tomography (CT)-guided microcoil placement followed by ICG tumor mapping by VATS wedge resection were enrolled. After microcoil deployment, 100 to 150 ml of diluted ICG was injected percutaneously near the nodule. The nodule initially was localized solely by using a near-infrared ray (NIR) thoracoscope to visualize ICG fluorescence. Thoracoscopic instruments were used to determine the staple line. Wedge resection was performed after confirmation of the location of the microcoil using fluoroscopy and pathology results. Results Thirty patients underwent VATS resection. The median tumor size was 1.3 cm by CT. The median depth from the pleural surface was 1.7 cm (range: 0.5–3.8 cm). The median CT-guided intervention time was 25 min, and VATS procedural time was 50 min. ICG fluorescence was clearly identified in 30 of 30 patients (100%). The surgical margins were all negative on final pathology in all included cases. The final diagnoses were 30 primary lung cancers; none needed additional resection. Conclusions CT-guided percutaneous ICG injection and intraoperative NIR localization of small nodules are safe and feasible. These offer surgeons the ease of localization through direct indocyanine green fluorescence imaging without the use of fluoroscopy and may be a complementary technique to preoperative microcoil placement for nonvisible, nonpalpable intrapulmonary nodules.
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10
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Yamamoto M, Ninomiya H, Miyashita K, Tashiro M, Orihashi K, Inoue K, Sato T, Hanazaki K. Influence of residual coronary flow on bypass graft flow for graft assessment using near-infrared fluorescence angiography. Surg Today 2019; 50:76-83. [PMID: 31346810 DOI: 10.1007/s00595-019-01850-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/07/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Near-infrared fluorescence angiography (NIR) detects the attenuation of fluorescence luminance intensity (FLI) through coronary artery bypass grafts affected by anastomotic stenosis. This study investigates the influence of residual blood flow of the host coronary artery (Ho) on bypass graft (Gr) FLI using a coronary artery bypass (CABG) model. METHODS A mock circuit system was created using artificial vessels and artificial blood was supplied to the Gr and the Ho. We used NIR to examine the changes in FLI through the Gr. RESULTS The Gr FLI was significantly attenuated according to the degree of Gr stenosis. The Gr FLI did not differ significantly among all degrees of Ho stenosis. High FLI grafts included grafts with degrees of Gr stenosis ≤ 75%, regardless of the severity of Ho stenosis. Moderate and low FLI grafts had 90 or 99% Gr stenosis, regardless of the severity of Ho stenosis. Gr FLI with 99% Gr stenosis was higher in 99% Ho stenosis than in ≤ 90% Ho stenosis. CONCLUSIONS A high Gr FLI indicated the absence of ≥ 90% stenosis in the anastomosis and a low Gr FLI indicated severe stenosis in the anastomosis despite Ho stenosis. High Ho stenosis may prevent the attenuation of Gr FLI in severely stenosed grafts.
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Affiliation(s)
- Masaki Yamamoto
- Department of Operations Management, Kochi Medical School Hospital, Kochi University, Kohasu 185-1, Oko, Nankoku, Kochi, 783-8505, Japan. .,Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi, Japan. .,Department of Cardiovascular Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi, Japan.
| | - Hitoshi Ninomiya
- Department of Civil and Environmental Engineering, Toyo University, Kawagoe, Saitama, Japan
| | - Kohei Miyashita
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi, Japan
| | - Miwa Tashiro
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi, Japan
| | - Kazumasa Orihashi
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi, Japan.,Department of Cardiovascular Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi, Japan.,Department of Urology, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi, Japan.,Department of Cardiovascular Control, Kochi University, Nankoku, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Operations Management, Kochi Medical School Hospital, Kochi University, Kohasu 185-1, Oko, Nankoku, Kochi, 783-8505, Japan.,Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi, Japan.,Department of Surgery 1, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi, Japan
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11
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Matsuura Y, Mun M, Ichinose J, Nakao M, Nakagawa K, Okumura S. Recent fluorescence-based optical imaging for video-assisted thoracoscopic surgery segmentectomy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:32. [PMID: 30854385 DOI: 10.21037/atm.2019.01.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The importance of fluorescence-based optical imaging in various fields of surgery is increasing. This is a prospective cohort study aimed to investigate the feasibility and efficacy of indocyanine-green fluorescence (ICGF)-based navigation for near-infrared (NIR) thoracoscopic segmentectomy. Methods ICGF-based video-assisted thoracoscopic surgery (VATS) segmentectomy was performed in 149 patients. Each patient underwent preoperative evaluation by multidetector-row computed tomography (MDCT), which provided three-dimensional simulations of vascular structures, segmental bronchi, and lung tumor. During the procedure, low-dose ICG (0.25 mg/kg) was injected systemically after the target segmental pulmonary arteries and bronchus were divided. Under NIR-thoracoscopic guidance, an ICG fluorescent line was marked by electric scalpel, followed by division of lung parenchyma along the line by electric scalpel or endoscopic staples. Results An intersegmental line of ICGF was visible in 98% of patients, even with the use of low-dose ICG. Neither ICG-related adverse events nor procedure-related major complications occurred. The 5-year overall (OS) and recurrence-free survival (RFS) rates were 91.8% and 98%, respectively. Localized recurrence at the resected site did not occur in any patient. Conclusions ICGF-based navigation for NIR VATS segmentectomy for patients with lung cancer is feasible and effective.
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Affiliation(s)
- Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ken Nakagawa
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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12
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Namikawa T, Fujisawa K, Munekage E, Iwabu J, Uemura S, Tsujii S, Maeda H, Kitagawa H, Fukuhara H, Inoue K, Sato T, Kobayashi M, Hanazaki K. Clinical application of photodynamic medicine technology using light-emitting fluorescence imaging based on a specialized luminous source. Med Mol Morphol 2018; 51:187-193. [PMID: 29619546 DOI: 10.1007/s00795-018-0190-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/02/2018] [Indexed: 02/08/2023]
Abstract
The natural amino acid 5-aminolevulinic acid (ALA) is a protoporphyrin IX (PpIX) precursor and a new-generation photosensitive substance that accumulates specifically in cancer cells. When indocyanine green (ICG) is irradiated with near-infrared (NIR) light, it shifts to a higher energy state and emits infrared light with a longer wavelength than the irradiated NIR light. Photodynamic diagnosis (PDD) using ALA and ICG-based NIR fluorescence imaging has emerged as a new diagnostic technique. Specifically, in laparoscopic examinations for serosa-invading advanced gastric cancer, peritoneal metastases could be detected by ALA-PDD, but not by conventional visible-light imaging. The HyperEye Medical System (HEMS) can visualize ICG fluorescence as color images simultaneously projected with visible light in real time. This ICG fluorescence method is widely applicable, including for intraoperative identification of sentinel lymph nodes, visualization of blood vessels in organ resection, and blood flow evaluation during surgery. Fluorescence navigation by ALA-PDD and NIR using ICG imaging provides good visualization and detection of the target lesions that is not possible with the naked eye. We propose that this technique should be used in fundamental research on the relationship among cellular dynamics, metabolic enzymes, and tumor tissues, and to evaluate clinical efficacy and safety in multicenter cooperative clinical trials.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan.
| | - Kazune Fujisawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Eri Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Shigehiro Tsujii
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Cancer Treatment Center, Kochi Medical School Hospital, Kochi, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hideo Fukuhara
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
- Department of Urology, Kochi Medical School, Kochi, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
- Department of Urology, Kochi Medical School, Kochi, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
- Department of Cardiovascular Control, Kochi Medical School, Kochi, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Kochi, Japan
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
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13
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Yamamoto M, Ninomiya H, Tashiro M, Sato T, Handa T, Inoue K, Orihashi K, Hanazaki K. Evaluation of graft anastomosis using time-intensity curves and quantitative near-infrared fluorescence angiography during peripheral arterial bypass grafting. J Artif Organs 2018; 22:160-168. [PMID: 30467613 DOI: 10.1007/s10047-018-1083-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/11/2018] [Indexed: 01/29/2023]
Abstract
Near-infrared fluorescence angiography (NIR) visualizes blood perfusion using the fluorescence property of indocyanine green (ICG). This study aimed to retrospectively determine the usefulness of a quantitative analysis using NIR to predict the patency of peripheral arterial bypass grafts by measuring their fluorescence luminance intensities (FLIs).Thirteen grafts in 11 patients who underwent peripheral arterial bypass grafting were divided into a patent graft group (n = 7) and a failed graft group (n = 6). The changes in the FLIs of ICG opacification through the graft and distal host artery were retrospectively analyzed using stored NIR data. The time-intensity curves (TICs) of ICG opacification through the graft (Qgraft) and distal host artery (Qdistal) were measured. Two parameters, Δ(Qgraft - Qdistal) and integral(Qgraft - Qdistal), were also analyzed.Although not significant, decreases in Qgraft were observed in the failed graft groups. The Qdistal of the failed graft group was significantly attenuated as compared with that of the patent graft group. Δ(Qgraft - Qdistal) increased only in the failed graft group, which indicates widening of the gap in FLI. Integral(Qgraft - Qdistal) was higher in the failed graft group, as it reflects the accumulation of ICG opacification.The TICs were influenced by anastomotic stenosis in the distal site of the host arteries. Our results indicate that the comparison of Δ(Qgraft - Qdistal) and integral (Qgraft - Qdistal) quantitatively analyzed using NIR can potentially predict anastomotic stenosis.
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Affiliation(s)
- Masaki Yamamoto
- Department of Operating Management, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan. .,Department of Surgery 2, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan. .,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.
| | - Hitoshi Ninomiya
- Integrated Centre for Advanced Medical Technologies, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Faculty of Science and Engineering, Department of Civil and Environmental Engineering, Toyo University, 2100, Kujirai, Kawagoe, Saitama, 350-8585, Japan
| | - Miwa Tashiro
- Department of Surgery 2, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Department of Cardiovascular Control, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
| | - Takemi Handa
- Department of Surgery 2, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Department of Urology, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
| | - Kazumasa Orihashi
- Department of Surgery 2, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
| | - Kazuhiro Hanazaki
- Department of Operating Management, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Department of Surgery 1, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
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14
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Mesenteric ischemia in acute aortic dissection. Gen Thorac Cardiovasc Surg 2018; 66:557-564. [DOI: 10.1007/s11748-018-0970-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
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15
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Yamamoto M, Ninomiya H, Tashiro M, Nishimori H, Inoue K, Sato T, Hanazaki K, Orihashi K. A Case of Anastomotic Stenosis of a Peripheral Arterial Bypass Graft Undetected in Indocyanine Green Angiography. Ann Vasc Dis 2018; 11:233-235. [PMID: 30116417 PMCID: PMC6094034 DOI: 10.3400/avd.cr.17-00122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report the case of a 75-year-old man who underwent right femoral-popliteal bypass surgery. Anastomotic stenosis was overlooked in indocyanine green (ICG) angiography due to opacification on the bypass graft. X-ray angiography revealed slit-shaped stenosis in the distal graft anastomosis that required revision. Although blood flow may be maintained despite of anastomotic stenosis, small decreases in blood flow cannot be detected in ICG angiography. We describe and discuss the pitfalls of qualitative graft assessment using ICG angiography, and compare ICG fluorescence luminance intensity between primary and revised grafts.
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Affiliation(s)
- Masaki Yamamoto
- Department of Operating Management, Kochi Medical School, Kochi University, Kochi, Japan.,Department of Surgery 2, Kochi Medical School, Kochi University, Kochi, Japan.,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hitoshi Ninomiya
- Integrated Centre for Advanced Medical Technologies, Kochi Medical School, Kochi University, Kochi, Japan
| | - Miwa Tashiro
- Department of Surgery 2, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hideaki Nishimori
- Department of Surgery 2, Kochi Medical School, Kochi University, Kochi, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kochi, Japan.,Department of Urology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kochi, Japan.,Department of Cardiovascular Control, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Operating Management, Kochi Medical School, Kochi University, Kochi, Japan.,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kochi, Japan.,Department of Surgery 1, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kazumasa Orihashi
- Department of Surgery 2, Kochi Medical School, Kochi University, Kochi, Japan.,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kochi, Japan
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16
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Nagaya T, Nakamura YA, Choyke PL, Kobayashi H. Fluorescence-Guided Surgery. Front Oncol 2017; 7:314. [PMID: 29312886 PMCID: PMC5743791 DOI: 10.3389/fonc.2017.00314] [Citation(s) in RCA: 261] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/05/2017] [Indexed: 01/02/2023] Open
Abstract
Surgical resection of cancer remains an important treatment modality. Despite advances in preoperative imaging, surgery itself is primarily guided by the surgeon’s ability to locate pathology with conventional white light imaging. Fluorescence-guided surgery (FGS) can be used to define tumor location and margins during the procedure. Intraoperative visualization of tumors may not only allow more complete resections but also improve safety by avoiding unnecessary damage to normal tissue which can also reduce operative time and decrease the need for second-look surgeries. A number of new FGS imaging probes have recently been developed, complementing a small but useful number of existing probes. In this review, we describe current and new fluorescent probes that may assist FGS.
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Affiliation(s)
- Tadanobu Nagaya
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Yu A Nakamura
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Hisataka Kobayashi
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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17
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Zhai Q, Wang Y, Tian A. Severe hemodynamic instability after indocyanine green injection during off-pump coronary artery bypass grafting: A case report. Medicine (Baltimore) 2017; 96:e8766. [PMID: 29145331 PMCID: PMC5704876 DOI: 10.1097/md.0000000000008766] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The increasingly intraoperative use of indocyanine green (ICG) means that it is necessary to be aware of both its advantages and potential adverse effects. PATIENT CONCERNS A 76-year-old woman developed symptoms of sudden severe hemodynamic instability while undergoing coronary artery bypass grafting with ICG injection to detect the patency of the graft. The main clinical manifestations were a sudden drop in blood pressure and increased heart rate. DIAGNOSES Severe side effects or allergic reaction of ICG. INTERVENTIONS Cardiopulmonary bypass (CPB) was established, and an intra-aortic balloon pump was implanted in the left femoral artery after intravenous epinephrine and manual cardiac compression failed. OUTCOMES The patient was extubated and transferred to the general ward on the third postoperative day. LESSONS Invasive blood pressure monitoring should be carried out in patients undergoing intraoperative ICG administration. Anesthetists should pay close attention to the patient's hemodynamic fluctuations, and effective emergency measures should be implemented immediately if severe hemodynamic instability occurs.
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18
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Yamamoto M, Nishimori H, Fukutomi T, Yamaguchi T, Orihashi K. Dynamics of Oxidative Stress Evoked by Myocardial Ischemia Reperfusion After Off-Pump Coronary Artery Bypass Grafting Elucidated by Bilirubin Oxidation. Circ J 2017; 81:1678-1685. [PMID: 28592749 DOI: 10.1253/circj.cj-16-1116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2024]
Abstract
BACKGROUND Revascularization therapy relieves myocardial ischemia, but can also result in ischemia-reperfusion injury caused by oxidative stress. However, the biokinetics of oxidative stress after myocardial ischemia-reperfusion are uncertain. This study aimed to evaluate the dynamics of oxidative stress after off-pump coronary artery bypass grafting (OPCAB) by measuring urinary biopyrrin levels. Biopyrrin is an oxidative metabolite of bilirubin thought to reflect oxidative stress, along with reactive nitrogen species (RNS). METHODS AND RESULTS The study included 18 patients who underwent OPCAB; patients were divided into effort angina pectoris (EAP; n=11) and unstable angina pectoris (UAP; n=7). Urinary biopyrrin and RNS levels were measured during the perioperative period (≤48 h after surgery). Biopyrrin levels transiently increased 4-12 h post-surgery (early phase), followed by a prolonged increase approximately 24-32 h post-surgery (late phase). The delayed increase in biopyrrin tended to be higher in patients with UAP, with a simultaneous increase in RNS. The patients in the UAP group had generally high pulmonary capillary wedge pressure (PCWP), although the cardiac index was within a normal range during the delay phase. CONCLUSIONS The dynamics of biopyrrin levels revealed a biphasic pattern of oxidative stress after OPCAB. Delayed production of oxidative stress may be influenced by preoperative severity of myocardial ischemia and delayed RNS production.
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Affiliation(s)
- Masaki Yamamoto
- Departments of Surgery 2 and Cardiovascular Surgery, Kochi Medical School
| | - Hideaki Nishimori
- Departments of Surgery 2 and Cardiovascular Surgery, Kochi Medical School
| | - Takashi Fukutomi
- Departments of Surgery 2 and Cardiovascular Surgery, Kochi Medical School
| | - Tokio Yamaguchi
- Department of Biochemical Genetics, Medical Research Institute, Tokyo Medical and Dental University
| | - Kazumasa Orihashi
- Departments of Surgery 2 and Cardiovascular Surgery, Kochi Medical School
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19
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Kitagawa H, Namikawa T, Iwabu J, Hanazaki K. Gastric Tube Reconstruction with Superdrainage Using Indocyanine Green Fluorescence During Esophagectomy. In Vivo 2017; 31:1019-1021. [PMID: 28882975 PMCID: PMC5656845 DOI: 10.21873/invivo.11163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/04/2017] [Accepted: 08/06/2017] [Indexed: 02/08/2023]
Abstract
We report a case of gastric tube reconstruction with superdrainage using indocyanine green fluorescence during esophagectomy for esophageal cancer. A 53-year-old man with a history of early esophageal cancer treated with endoscopic mucosal dissection experienced esophageal cancer recurrence. There was no evidence of lymph node involvement or distant metastasis on computed tomography; therefore, we performed thoracoscopic esophagectomy. After thoracoscopic esophagectomy, we created a gastric tube. When pulling up the gastric tube through the post-mediastinum route, a root of the right gastroepiploic vein was injured. We subsequently performed superdrainage to avoid congestion of the gastric tube with omental vein and pre-tracheal vein anastomosis at the neck, and confirmed venous flow using the indocyanine green fluorescence method. No postoperative anastomotic leakage was observed, and the patient was discharged 22 days after surgery. Thus, we recommend the indocyanine green fluorescence method in cases involving superdrainage during esophagectomy.
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Affiliation(s)
| | | | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Nankoku, Japan
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20
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Influence of vessel stenosis on indocyanine green fluorescence intensity assessed by near-infrared fluorescence angiography. Surg Today 2016; 47:877-882. [PMID: 27913886 DOI: 10.1007/s00595-016-1453-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/04/2016] [Indexed: 02/03/2023]
Abstract
PURPOSE Although useful for visualizing blood flow during revascularization surgery, the permeability of near-infrared fluorescence (NIR) angiography using indocyanine green (ICG) does not allow for vessel stenosis visualization. We hypothesized that changes in ICG fluorescence intensity reflect vessel stenosis, and evaluated the influence of stenosis on blood flow by ex vivo experimentation. METHODS The vessel stenosis model comprised a silicon tube, a graft occluder, and artificial blood. During near-infrared angiography, the fluorescense intensity was calculated during pre- and post-stenosis of an artificial circuit, using a NIR angiography. We measured the maximum fluorescence intensity and the time to maximum fluorescence intensity. RESULTS Severe stenosis (≥75%) attenuated the increase in ICG fluorescence intensity in the tube significantly, pre- and post-stenosis. The time to maximum fluorescence intensity did not differ between sites pre- and post-stenosis, irrespective of stenosis severity. CONCLUSION Stenosis affected the ICG fluorescence intensity through the vessel. Thus, quantitative analysis using NIR angiography may detect severe vessel stenosis (≥75%), and the extinction curve of indocyanine fluorescence intensity may support the evaluation of blood flow. The absence of differences in the time to maximum fluorescence intensity for degrees of stenosis might suggest a limitation of previous conventional qualitative assessments.
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21
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Yoshida S, Numata S, Tsutsumi Y, Monta O, Yamazaki S, Seo H, Samura T, Ohashi H. Short- and long-term results of radial artery and saphenous vein grafts in the right coronary system: a propensity-matched study. Surg Today 2016; 47:335-343. [PMID: 27506754 DOI: 10.1007/s00595-016-1396-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 06/14/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE The selection of optimal grafts for the right coronary artery remains controversial. This study aims to evaluate the short- and long-term results of radial artery (RA) grafts and saphenous vein grafts (SVGs) to the right coronary artery. METHODS We reviewed, retrospectively, isolated coronary artery bypass grafts, placed between 1997 and 2007, and compared the long-term results of patients who received RA (n = 110) grafts with those of patients who received SVGs (n = 264) using propensity-score matching for risk. The preoperative predictors of graft occlusion were investigated on a per case basis. RESULTS Superior survival was noted in the unmatched RA group, but late outcomes after propensity-score matching yielded 91 patient pairs that were similar in the two groups. Graft failure was not correlated with mortality, but showed strong correlation with cardiac events in all patients. The predictors of graft occlusion in the RA group were mild proximal stenosis and low indexing glomerular filtration rates for body surface area, whereas those in the SVG were female gender and off-pump coronary artery bypass grafting. CONCLUSIONS There were no significant differences in long-term outcomes between the RA and SVG groups. Predictors of graft occlusion differed between the groups. Notably, renal dysfunction impaired radial patency, emphasizing the importance of careful graft selection.
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Affiliation(s)
- Shohei Yoshida
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Shinbo 2-228, Fukui, 910-0833, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Shinbo 2-228, Fukui, 910-0833, Japan.
| | - Yasushi Tsutsumi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Shinbo 2-228, Fukui, 910-0833, Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Shinbo 2-228, Fukui, 910-0833, Japan
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Shinbo 2-228, Fukui, 910-0833, Japan
| | - Hiroyuki Seo
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Shinbo 2-228, Fukui, 910-0833, Japan
| | - Takaaki Samura
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Shinbo 2-228, Fukui, 910-0833, Japan
| | - Hirokazu Ohashi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Shinbo 2-228, Fukui, 910-0833, Japan
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Nakamura T, Toda K, Miyagawa S, Yoshikawa Y, Fukushima S, Saito S, Yoshioka D, Yajima S, Yoshida S, Sawa Y. Symptomatic peripheral artery disease is associated with decreased long-term survival after coronary artery bypass: a contemporary retrospective analysis. Surg Today 2016; 46:1334-40. [DOI: 10.1007/s00595-016-1379-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/26/2016] [Indexed: 01/25/2023]
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23
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Quantitative assessment technique of HyperEye medical system angiography for coronary artery bypass grafting. Surg Today 2016; 47:210-217. [PMID: 27352196 DOI: 10.1007/s00595-016-1369-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The HyperEye Medical System (HEMS) uses indocyanine green (ICG) to visualize blood vessels in coronary artery bypass grafting (CABG). We performed quantitative HEMS assessment to detect grafts at risk of occlusion. METHODS We assessed the HEMS angiograms of 177 grafts from 69 patients who underwent CABG and compared the results with those of fluoroscopic coronary angiography, by measuring the increasing rate of ICG intensity, average acceleration value, and time to peak luminance intensity. RESULTS Grafts in the patent and failed groups showed significant differences in their increasing rate of intensity and average acceleration value. The average accelerations value of ICG intensity of internal thoracic artery (ITA) and saphenous vein (SV) grafts were 112.3 and 144.9 intensity/s2 in the patent group, and 71.0 and 91.8 intensity/s2 in the failed group. The time to peak luminance intensity was 1.7 and 1.4 s in the patent group and 2.3 and 1.9 s in the failed group; these values were not significantly different. CONCLUSION Significant reductions in the ICG intensity rate and average acceleration value can occur in failed grafts. Therefore, quantifiable changes in ICG intensity may help detect minute changes in blood flow.
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Maximal blood flow acceleration analysis in the early diastolic phase for aortocoronary artery bypass grafts: a new transit-time flow measurement predictor of graft failure following coronary artery bypass grafting. Surg Today 2016; 46:1325-33. [DOI: 10.1007/s00595-016-1325-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
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Namikawa T, Sato T, Hanazaki K. Recent advances in near-infrared fluorescence-guided imaging surgery using indocyanine green. Surg Today 2015; 45:1467-1474. [PMID: 25820596 DOI: 10.1007/s00595-015-1158-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/09/2015] [Indexed: 02/08/2023]
Abstract
Near-infrared (NIR) fluorescence imaging has better tissue penetration, allowing for the effective rejection of excitation light and detection deep inside organs. Indocyanine green (ICG) generates NIR fluorescence after illumination by an NIR ray, enabling real-time intraoperative visualization of superficial lymphatic channels and vessels transcutaneously. The HyperEye Medical System (HEMS) can simultaneously detect NIR rays under room light to provide color imaging, which enables visualization under bright light. Thus, NIR fluorescence imaging using ICG can provide for excellent diagnostic accuracy in detecting sentinel lymph nodes in cancer and microvascular circulation in various ischemic diseases, to assist us with intraoperative decision making. Including HEMS in this system could further improve the sentinel lymph node mapping and intraoperative identification of blood supply in reconstructive organs and ischemic diseases, making it more attractive than conventional imaging. Moreover, the development of new laparoscopic imaging systems equipped with NIR will allow fluorescence-guided surgery in a minimally invasive setting. Future directions, including the conjugation of NIR fluorophores to target specific cancer markers might be realistic technology with diagnostic and therapeutic benefits.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Takayuki Sato
- Department of Cardiovascular Control, Kochi Medical School, Nankoku, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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