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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3721_Библиотеки_им_академика_М_И_Перельмана
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Takeaki Ishizawa Editor
With Contribution by
Japanese Society for Fluorescence
Guided Surgery (JSFGS)
Fluorescence-Guided
Surgery
From Lab to Operation Room
123
Fluorescence-Guided Surgery
Takeaki Ishizawa
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Editor
Fluorescence-Guided Surgery
From Lab toOperation Room
Editor
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Takeaki Ishizawa
Department of Hepatobiliary-Pancreatic Surgery
Graduate School of Medicine
Osaka Metropolitan University
Osaka, Japan
Contribution by
Japanese Society for Fluorescence Guided Surgery (JSFGS)
Tokyo, Japan
ISBN 978-981-19-7371-0 ISBN 978-981-19-7372-7 (eBook)
https://doi.org/10.1007/978-981-19-7372-7
The translation was done with the help of articial intelligence (machine translation by the service DeepL.com).
A subsequent human revision was done primarily in terms of content.
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
This English edition was published as a co-edition with its original Japanese language edition, Jutsuchu Keikou
Imaging Jissen Guide– Labo kara Opeshitu made-, copyright © 2020 by Medical View Co., Ltd., Tokyo Japan. This
work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is
concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction
on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore
Foreword 1
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Fluorescence imaging, especially the use of indocyanine green (ICG), is a technology that
originated in Japan, and many innovations and clinical applications of uorescence-guided
surgery using ICG have been made in Japan. Today we commonly use these techniques and
methods in a wide range of medical elds and disciplines, and the standardization and internationalization of these methods is progressing year by year. Surgical eld physicians have
applied this technique to vascular imaging, lymphatic and lymph node imaging, and imaging
to identify anatomical structures. The scope of application is very wide, and the application
procedure is also diverse.
In this book, the authors provide state-of-the-art information by disease area, application
methodology, and historical background. The authors' enthusiasm for uorescence imaging
and uorescence-guided surgery is evident in their excellent results, ideas, and perspectives.
The authors provide essential practical information on the technique, such as agent injection
timing and localization, amount of administration, details of the equipment, novel projection
systems, new uorescent probes, and combinations with other imaging techniques. On the
other hand, there are examples of increased integration with therapy that has resulted in signicant improvements in treatment outcomes. Fluorescence-based techniques and surgery, along
with other therapeutic advances, have revolutionized in various areas. In addition, we will
discuss not only the benets of this method, but also its limitations and challenges. This information is also extremely useful. Fluorescent imaging, integrated into endoscopic surgery and
robotic surgery, plays a key role in the evolution of smart operating rooms. Articial intelligence will detect uorescent signals in near future. Accumulation of efforts to maximize the
advantages and overcome the challenges will contribute to the overall progress of surgery.
Training is essential for learning new techniques. This book contains information on education and management of uorescence-guided surgery, such as recording and video recording
methods, links to medical records, and information systems. In addition, as you read this book
through, there are organ-specic differences in the details of applications and methodologies
that will help you better understand uorescent-guided surgery.
The book contains a variety of future perspectives, including new uorescent agents, nextgeneration equipment, and operating rooms. This book is full of beautiful illustrations, easy to
understand, and has a simple yet detailed structure to help you nd the essence of the subject.
Finally, I believe that the further development and evolution of uorescence imaging technique and surgery and the creation of new concepts will continue, which will benet patients.
Professor, Breast Surgery
Graduate School of Medicine, Kyoto University
Representative Director Japanese Society
for Fluorescence Guided Surgery (JSFGS)
Kyoto, Japan
July 2022
MasakazuToi
v
Foreword 2
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I still remember how impressed I was when I saw the ICG uorescence imaging technique
applied for the rst time in the spring of 2007 by Dr. Takeaki Ishizawa, the editor of this book,
in the OR at the University of Tokyo Hospital. I immediately felt that this technique would
denitely be useful. It may be a cliché, but "seeing is believing," and all the members of the
medical staff who saw the beautiful, clear uorescent images were captivated by them. The
Nobel Prize-winning GFP by Dr. Osamu Shimomura brought epoch-making progress in life
science, and I believe that uorescent imaging using ICG, which is almost non-toxic to the
human body, excreted in bile, and available at low cost, is a Nobel Prize-class technology in
terms of clinical impact.
The ICG uorescence imaging technique has been applied to many areas of hepatobiliary
surgery, including uorescence cholangiography (especially in endoscopic surgery), hepatocellular carcinoma imaging, hepatic segmental staining, and visualization of cholestatic areas
in the liver. The ICG uorescence method has expanded to many areas, including blood ow
evaluation of the gastrointestinal tract and transplanted liver, lymphangiography, and others.
Collaboration with Dr. Yasuteru Urano, a basic medical scientist and an expert in the synthesis
of uorescent materials, was also a great fortunate encounter. New ideas such as cancer imaging and pancreatic uid imaging using new uorescent probes developed by Dr. Urano were
born one after another.
The ICG Fluorescence Navigation Study Group, organized by Dr. Mitsuo Kusano, one of
the pioneers of ICG uorescence imaging, started in 2008 as a gathering of surgeons fascinated
by this new technology. We invited Dr. Hisataka Kobayashi at NIH, who was an expert in photoimmunotherapy, a research area of great clinical signicance as a treatment beyond imaging.
In May 2020, the Ministry of Health, Labour and Welfare (MHLW) of Japan approved the use
of ASP-1929 photoimmunotherapy for head and neck cancer. We look forward to further progress in this clinical trial.
The international expansion of ICG uorescence imaging in the eld of hepatobiliary and
pancreatic surgery is largely due to the energetic networking efforts of Dr. Takeaki Ishizawa.
As described in "COLUMN 2" of this report, Dr. Ishizawa met with Argentine surgeon
Fernando Dip at the International Hepatobiliary and Pancreatic Surgery Association (IHPBA)
meeting held in Buenos Aires in 2010, and Dr. Dip introduced this technique to Professor
Rosenthal at the Department of Surgery, Cleveland Clinic in Florida, where Dr. Dip moved to.
Together with Professor Michael Bouvet of the Department of Surgery at UC San Diego, we
founded the International Society for Fluorescence Guided Surgery (ISFGS) in 2014. Back in
Japan, the ICG Fluorescence Navigation Study Group was transformed to the Japan Society
for Fluorescence Guided Surgery (JSFGS) in 2018 to promote international collaboration in
this eld.
vii
viii
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The publication of this guidebook covering the latest knowledge and techniques of intraoperative uorescence imaging at this time is truly timely, and we would like to express our sincere appreciation and respect to Dr. Takeaki Ishizawa, the editor, Dr. Masakazu Toi, the
supervisor, and all others involved.
NorihiroKokudo
President, National Center for Global Health and Medicine
Tokyo,Japan
Executive Director, Japanese Society
for Fluorescence Guided Surgery (JSFGS)
Tokyo,Japan
July 2022
Foreword 2
Preface
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In April 2018, the rst annual meeting of the “Japanese Society for Fluorescence Guided
Surgery (JSFGS)” was held in Tokyo. More than 200 physicians, researchers, and business
people gathered for a lively exchange of opinions that transcended the boundaries of their
elds of expertise. This book is a guidebook on the development and clinical application of
intraoperative uorescence imaging, based on the program of the rst meeting. We are very
honored to have the opportunity to publish the English version, which will be of practical use
to more and more people working on “uorescence-guided surgery” in the world.
“Fluorescence-guided surgery" is a surgical procedure that aims to improve outcomes by
using intraoperative uorescence imaging to identify target biological structures and evaluate
organ function and blood perfusion. Today, intraoperative uorescence imaging is beginning
to be implemented in almost every surgical department, literally from head to toe, for one
application or another. The primary users of this technology are denitely surgeons in the
operating room. However, the understanding of nurses, medical engineers, and manufacturers
is also essential for the safe and effective use of uorescent imaging. On the other hand, new
uorescent probes and next-generation imaging devices are being developed each day in
research laboratories in university and company. In these circumstances, the main purpose of
this book is to share basic knowledge about intraoperative uorescence imaging and to serve
as a guidebook to facilitate the exchange of information for the next step. To achieve this goal,
the editorial process was guided by the following principles
1. To serve as a guide for the introduction of uorescent probes and imaging devices into the
operating room: The book covers all uorescent probes and imaging devices currently
available for clinical use in Japan and lists the features of each product (Introduction).
2. To be a practical guide across the medical departments: The “Practice” part is organized
by application of uorescence imaging (i.e., perfusion assessment, cancer identication,
lymph node mapping/lymphography, anatomy visualization) rather than by organ. The
book is richly illustrated with intraoperative photographs and videos to show the effectiveness of the techniques, and at the same time, knacks and pitfalls in their application are also
clearly stated.
3. To be a guide for research and development bridging the operating room and the labora-
tory: At the beginning of each chapter of the practice parts, we have presented the challenges of conventional surgical methods. In contrast, the development part introduces the
latest technologies that are being applied to medical treatment, including clinical veterinary
medicine. We hope to match the seeds of researchers with the needs of clinicians.
4. To serve as a guide for presentations at academic conferences and papers: In the explana-
tion of the development history and current status of each technology, we have tried to
provide examples of rst reports and major papers with a high level of evidence that should
be cited in future presentations.
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We hope that this guidebook will help intraoperative uorescence imaging to develop into
a truly useful technology for patient care. Finally, I would like to express my sincere gratitude
to all those who have guided and supported the development of this guidebook and the activities of the JSFGS.
Osaka, Japan TakeakiIshizawa
September 2020
Preface
Contents
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Part I Basics of Intraoperative Fluorescence Imaging [Introduction]
1 Clinically Available Fluorescent Reagents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Kosuke Matsui and Masaki Kaibori
2 Indocyanine Green Fluorescence Imaging System for Open Surgery . . . . . . . . . . 7
Nobuyuki Takemura and Norihiro Kokudo
3 Indocyanine Green Fluorescence Imaging System for Endoscopic
and Robot-Assisted Surgeries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Shuichi Watanabe, Toshiro Ogura, Hironobu Baba, Yusuke Kinugasa,
and Minoru Tanabe
4 5-Aminolevulinic Acid Fluorescence Imaging System . . . . . . . . . . . . . . . . . . . . . . . 19
Tsutomu Namikawa and Kazuhiro Hanazaki
5 How to Introduce Fluorescence Imaging to the Operating Room . . . . . . . . . . . . . 25
Sunao Uemura, Tsutomu Namikawa, and Kazuhiro Hanazaki
6 Recording of Intraoperative Fluorescence Imaging . . . . . . . . . . . . . . . . . . . . . . . . 29
Koshi Kumagai
Column 1: Establishment and Activities of JSFGS
(Japanese Society for Fluorescence Guided Surgery)
Part II Intraoperative Fluorescence Imaging [Practice] – Perfusion Assessment
7 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Masashi Yoshida
8 Coronary Angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Tohru Asai
9 Cerebral Angiography (Cerebral Aneurysm) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Yasuo Murai, Fumihiro Matano, and Akio Morita
10 Evaluation of Blood Perfusion in Skin Flaps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Keisuke Okabe and Kazuo Kishi
11 Evaluation of Blood Perfusion in the Upper Gastrointestinal Tract . . . . . . . . . . . 63
Kazuo Koyanagi, Soji Ozawa, Yamato Ninomiya, Kentaro Yatabe,
Itaru Higuchi, and Miho Yamamoto
12 Evaluation of Blood Perfusion in Colorectal Surgery . . . . . . . . . . . . . . . . . . . . . . . 69
Hiro Hasegawa, Yuichiro Tsukada, and Masaaki Ito
13 Perfusion Assessment in HBP Surgery and Liver Transplantation . . . . . . . . . . . . 77
Satoru Seo
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