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Ultrasonography-guided hepatic tumor resection using a real-time virtual sonography with indocyanine green navigation (with videos)

  • Kazuhiko KasuyaEmail author
  • Katsutoshi Sugimoto
  • Bunsoh Kyo
  • Yuichi Nagakawa
  • Takahisa Ikeda
  • Yasuharu Mori
  • Tatehiko Wada
  • Minako Suzuki
  • Takeshi Nagai
  • Takao Itoi
  • Motohide Shimazu
  • Tatsuya Aoki
  • Akihiko Tsuchida
Topics Advances in therapeutic ultrasound and endoscopy in hepato-biliary-pancreatic diseases

Abstract

Purpose

For hepatic tumors that cannot be identified on routine ultrasonography (US), we marked the target area using real-time virtual sonography (RVS) with indocyanine green (ICG)–ethanol (1:100) during surgery, and performed hepatic resection while observing the fluorescence.

Experiment

An ICG–ethanol mixture locally injected into mouse liver was retained in the same area for more than 4 h. The same mixture locally injected into pig liver at a depth of 3 cm could be observed using an infrared camera.

Case

An ICG–ethanol mixture (500 μl) was locally injected under RVS guidance into a metastatic hepatic tumor that was visible only on magnetic resonance imaging (MRI), and hepatic resection was performed while Photodynamic Eye (PDE) images were being observed. The metastatic lesion (3 mm in diameter in a pathological specimen) could be successfully resected.

Conclusion

This method was useful for resecting US-invisible hepatic tumors.

Keywords

Liver Navigation surgery Real-time virtual sonography Indocyanine green 

Notes

Acknowledgments

This study was supported by a clinical research grant from the Cancer Center of Tokyo Medical University.

Supplementary material

Video 1 The needle stab was performed after synchronizing the MRI and US images in a respiratory arrest condition. The ICG solution was located as a strong circular echo (MPG 2777 kb)

Video 2 As the strong fluorescence meant that the operating room did not have to be dark, the PDE scan was performed in normal light. Therefore the operator was able to work without stress while watching the PDE (MPG 2775 kb)

Video 3 The fluorescence was visible at the hepatic surface through the non-fluorescent liver. The injected ICG emitted spherical (circular in the hepatic cut section) fluorescence at the tip of the needle and along the stab line of the needle on the hepatic cut section (MPG 1738 kb)

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Copyright information

© Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2010

Authors and Affiliations

  • Kazuhiko Kasuya
    • 1
    Email author
  • Katsutoshi Sugimoto
    • 2
  • Bunsoh Kyo
    • 1
  • Yuichi Nagakawa
    • 1
  • Takahisa Ikeda
    • 1
  • Yasuharu Mori
    • 1
  • Tatehiko Wada
    • 1
  • Minako Suzuki
    • 1
  • Takeshi Nagai
    • 3
  • Takao Itoi
    • 2
  • Motohide Shimazu
    • 4
  • Tatsuya Aoki
    • 1
  • Akihiko Tsuchida
    • 1
  1. 1.3rd Department of Digestive SurgeryTokyo Medical UniversityTokyoJapan
  2. 2.4th Department of Internal MedicineTokyo Medical UniversityTokyoJapan
  3. 3.Department of PathologyTokyo Medical UniversityTokyoJapan
  4. 4.Department of Digestive SurgeryHachioji Medical Center of Tokyo Medical UniversityTokyoJapan

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