About the VHIR
Here at the Vall d'Hebron Research Institute (VHIR) we promote biomedical research, innovation and teaching. Over 1,800 people are seeking to understand diseases today so the treatment can be improved tomorrow.
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Speaker: Prof. Takeaki Ishizawa, M.D., Ph.D., F.A.C.S. - Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Osaka Metropolitan University.
Abstract: Intraoperative fluorescence imaging using indocyanine green (ICG) has become used widely for real-time visualization of biological structures and assessment of blood perfusion. I herein demonstrate development history and clinical applications of ICG-fluorescence imaging to HBP surgery. 1) Fluorescence cholangiography: fluorescence images of the extrahepatic bile ducts can be obtained by intrabiliary injection of ICG solution (0.025 mg/mL) or preoperative intravenous injection (IV) of ICG (2.5 mg). The latter technique begins to be used worldwide for confirmation of the bile duct anatomy during minimally-invasive cholecystectomy. 2) Identification of hepatic tumors: IV-injected ICG (0.5 mg/kg) accumulates in hepatocellular carcinoma tissues and in non-cancerous hepatic parenchyma surrounding liver metastasis, which can be used for intraoperative identification of subcapsular hepatic tumors by fluorescence imaging. 3) Hepatic segmentation: ICG solution (0.25 mg in 5 mL indigo-carmine solution) is injected into a tumor-bearing portal branch under ultrasound guidance (positive staining technique). ICG can also be administered intravenously following closure of a corresponding portal pedicle (negative staining technique). These techniques enable long-lasting delineations of segmental boundaries throughout hepatectomy procedures because ICG retains in hepatocytes for more than 5 hours. 4) Assessment of blood perfusion: fluorescence imaging following intraoperative bolus IV ICG (2.5mg) visualizes arterial/portal blood flows and perfusions to the surrounding organs during surgeries with resection/reconstruction of major vessels. Along with current dissemination of ICG-fluorescence imaging, novel target-specific fluorophores and imaging devices are being developed actively. Our approach is to use enzyme-activatable fluorophores for real-time visualization of cancerous tissues and leaking pancreatic juice. The fluorescence imaging techniques will develop into an indispensable intraoperative navigation tool, enhancing safety and curability of HBP surgery.
Host:
Dr. Itxarone Bilbao, Hepatobiliopancreatic surgery and transplants, Children's Hospital and Woman's Hospital.
Dr. Concepción Gómez, Main researcher -Hepato-bilio-pancreatic surgery (HBP) and liver transplantation.
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