Page 2 - Journal of Laparoscopic Surgery

Editorial

Recently, major developments in video imaging have been taken place; among them,
the use of near-infrared fluorescence imaging is emerging as major contribution to
intraoperative decision making during minimal access surgical procedures. Many infrared
imaging systems are developed to determine the potential role of infrared imaging as a tool
for localizing anatomic structures and assessing tissue viability during laparoscopic and
robotic surgical procedures.
As we know, human eye cannot see infrared or ultraviolet rays, we can only see the
visual spectrum of the light. However, infrared emitted by near-infrared fluorescence
indocyanine green (ICG) can be captured by camera, an advantage now we have in the laparoscopy. There are
some dye which emits the infrared fluorescence like ICG, manufactured by the Kodak Company in 1954. After
two years, the FDA has approved the ICG for the mapping and angiography of the retina.
The ICG very tightly bind with the plasma protein and once injected in the peripheries circulates throughout
our circulatory system. Thereafter, it can be mapped by the laparoscopic camera. In cholecystectomy, we can
clearly see the cystic duct which is stained by the ICG. On setting the infrared sensitivity ON, the infrared light
will be stimulated by the blood vessels, it will be absorbed by the ICG, and in IR mode, it reflects the infrared
light, the filter of the camera will allow this infrared light to be seen. Different IR modes can magnify the
infrared light; like in the Olympus camera, IR mode 1 and IR mode 2 can be used for more precise viewing. In
IR mode it will be colored and we can see the infrared, and in IR mode 2 it will be black and white image, but
it can show us more perfusion. Different companies are coming with different techniques of using infrared in
their electronic circuits but overall their use is similar.
The ICG has a very short half-life; only it secretes into the liver and then comes out of body. It is very safe
and noise to image ratio is very good, i.e. it has very less noise and very good and high quality image. In
cholecystectomy, we have to inject the ICG 45 minutes before the procedure: the entire Calot’s triangle will be
visualized, we can see the common hepatic duct, common bile duct and cystic duct. The liver is also seen and
the liver is also completely profuses with ICG that also will emit the infrared green.You can use it for different
type of procedure like in the cholecystectomy to prevent the injury of CBD. In the other procedure like sleeve
gastrectomy, we inject the ICG only 2 minutes before the procedure. It can also be used for the liver resection and
for the nodules of metastasis of the liver. It can also be for the sentinel lymph node mapping in cervical cancer
and sleeve gastrectomy to find out the circulation of the blood circulation near the gastrosophegal junction. In
the mesorectal resection of the colon, it is injected approximately 5–7 minutes before the procedure. ICG-based
fluorescence imaging is very helpful in localization of prostate cancer and metastatic lymph nodes. There is
role of ICG for laparoscopic and robotic partial nephrectomy. The near-infrared technology will be able in
the future to better outline the way we perform endoscopy, laparoscopy and robotic surgery and therefore to
improve significantly patient outcomes and hospital costs.

RK Mishra
Editor-in-Chief
Chairman
World Laparoscopy Hospital
Gurugram, Haryana, India

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