• Journal of Gastric Cancer
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• 제12권1호
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• pp.7-12
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• 2012

More than ten years have passed since the sentinel node (SN) concept for gastric cancer surgery was first discussed. Less invasive modified surgical approaches based on the SN concept have already been put into practice for malignant melanoma and breast cancer, however the SN concept is not yet placed in a standard position in gastric cancer surgery even after two multi-institutional prospective clinical trials, the Japan Clinical Oncology Group trial (JCOG0302) and the Japanese Society for Sentinel Node Navigation Surgery (SNNS) trial. What is the problem in the clinical application of the SN concept to gastric cancer surgery? There is no doubt that we need reliable indicator(s) to determine with certainty the absence of metastasis in the lymph nodes in order to avoid unnecessary lymphadenectomy. There are several matters of debate in performing the actual procedure, such as the type of tracer, the site of injection, how to detect and harvest, how to detect metastases of SNs, and learning period. These issues have to be addressed further to establish the most suitable procedure. Novel technologies such as indocyanine green (ICG) fluorescence imaging and one-step nucleic acid amplification (OSNA) may overcome the current difficulties. Once we know what the problems are and how to tackle them, we can pursue the goal.

• Journal of Korean Neurosurgical Society
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• 제50권1호
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• pp.23-29
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• 2011

Objective : The aim of the study is to determine the efficacy of indocyanine green (ICG) videoangiography for confirmation of vascular anastomosis patency in both extracranial-intracranial and intracranial-intracranial bypasses. Methods : Intraoperative ICG videoangiography was used as a surgical adjunct for 56 bypasses in 47 patients to assay the patency of intracranial vascular anastomosis. These patients underwent a bypass for cerebral ischemia in 31 instances and as an adjunct to intracranial aneurysm surgery in 25. After completion of the bypass, ICG was administered to assess the patency of the graft. The findings on ICG videoangiography were then compared to intraoperative and/or postoperative imaging. Results : ICG provided an excellent visualization of all cerebral arteries and grafts at the time of surgery. Four grafts were determined to be suboptimal and were revised at the time of surgery. Findings on ICG videoangiography correlated with intraoperative and/or postoperative imaging. Conclusion : ICG videoangiography is rapid, effective, and reliable in determining the intraoperative patency of bypass grafts. It provides intraoperative information allowing revision to reduce the incidence of technical errors that may lead to early graft thrombosis.

• 대한의용생체공학회:의공학회지
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• 제42권3호
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• pp.116-124
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• 2021

It is important to differentiate between the target tissue (or organ) and the rest of the tissue before incision during surgery. And when it is necessary to preserve the differentiated tissues, the blood vessels connected to the tissue must be preserved together. Various non-invasive medical imaging methods have been developed for this purpose. We aimed to develop a medical imaging system that can simultaneously apply fluorescence imaging using indocyanine green (ICG) and laser speckle contrast imaging (LSCI) using laser speckle patterns. We designed to collect images directed to the two cameras on a co-axial optical path and to compensate equal optical path length for two optical designs. The light source used for fluorescence and LSCI the same 785 nm wavelength. This system outputs real-time images and is designed to intuitively distinguish target tissues or blood vessels. This system outputs LSCI images up to 37 fps through parallel processing. Fluorescence for ICG and blood flow in animal models were observed throughout the experiment.

• 대한소아치과학회지
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• 제47권4호
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• pp.446-453
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• 2020

이 연구의 목적은 Indocyanine Green(ICG)과 근적외선(Near Infrared, NIR) 다이오드 레이저가 Streptococcus mutans 세균막에 미치는 효과를 ICG 용액의 농도에 따라 평가하는 것이었다. Hydroxyapatite disk에 S. mutans 세균막을 형성하여 멸균 증류수에 용해시킨 0.5, 1.0, 2.0, 3.0, 4.0, 5.0 mg/mL의 ICG 용액과 300 mW의 출력, 808 nm의 파장을 가지는 NIR 다이오드 레이저를 적용하였다. 모든 표본은 공초점 레이저 주사 현미경(Confocal Laser Scanning Microscopy, CLSM)을 이용하여 관찰하였다. 또한 1채널 열전대 온도계와 Thermocouple을 이용하여 광조사 시에 ICG 용액의 농도에 따른 세균막 표면의 온도 변화를 함께 측정하였다. 대조군과 비교 시에 ICG 용액 만을 도포한 군에서는 3.0, 4.0, 5.0 mg/mL의 농도에서, 그리고 ICG 용액의 도포와 광조사를 함께 시행한 군에서는 1.0, 2.0, 3.0, 4.0, 5.0 mg/mL의 농도에서 통계적으로 유의한 세균 수의 감소가 관찰되었다. 용액의 농도에 따른 온도 증가량은 0.5, 1.0, 2.0, 3.0, 4.0, 5.0 mg/mL의 ICG 용액에서 각각 9.53℃, 10.43℃, 11.4℃, 12.1℃, 12.67℃, 13.63℃ 이었다. 즉, ICG 용액의 농도가 3.0 mg/mL이면 그 자체로도 S. mutans 세균막을 억제할 수는 있으나, NIR 다이오드 레이저를 함께 사용하면 주변 조직 손상의 우려 없이 더 효율적인 항균 작용을 나타낼 수 있다. 따라서, 이번 연구는 새로운 치아 우식증 예방법으로 ICG와 NIR 다이오드 레이저의 임상적 적용의 가능성을 제시한다.

• Journal of Gastric Cancer
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• 제20권3호
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• pp.290-299
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• 2020

Purpose: Recently, totally laparoscopic gastrectomy has been gradually accepted by surgeons worldwide for gastric cancer treatment. Complete dissection of the lymph nodes and the establishment of the surgical margin are the most important considerations for curative gastric cancer surgery. Previous studies have demonstrated that indocyanine green (ICG)-traced laparoscopic gastrectomy significantly improves the completeness of lymph node dissection. However, it remains difficult to identify the tumor location intraoperatively for gastric cancers that are staged ≤T3. Here, we investigated the feasibility of ICG fluorescence for lymph node mapping and tumor localization during totally laparoscopic distal gastrectomy. Materials and Methods: Preoperative and perioperative data from consecutive patients with gastric cancer who underwent a totally laparoscopic distal gastrectomy were collected and analyzed. The patients were categorized into the ICG (n=61) or the non-ICG (n=75) group based on whether preoperative endoscopic mucosal ICG injection was performed. Results: The ICG group had a shorter operation time and less intraoperative blood loss. Moreover, significantly more lymph nodes were harvested in the ICG group than the non-ICG group. No pathologically positive margin was found and there was no significant difference in either the proximal or distal surgical margins between the 2 groups. Conclusions: Near-infrared fluorescence imaging with ICG can be successfully used in totally laparoscopic distal gastrectomy, and it contributes to both the completeness of D2 lymph node dissection and confirmation of the gastric transection line. Well-designed prospective randomized studies are needed in the future to fully validate our findings.

• Journal of Gastric Cancer
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• 제18권2호
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• pp.161-171
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• 2018

Purpose: This study assessed the feasibility of near-infrared (NIR) imaging with indocyanine green (ICG) in investigating the completeness of laparoscopic lymph node (LN) dissection for gastric cancer. Materials and Methods: Patients scheduled for laparoscopic gastrectomy for treating gastric cancer were enrolled in the study. After intraoperative submucosal ICG injection (0.05 mg/mL), LN dissection was performed under conventional laparoscopic light. After dissection, the LN stations of interest were examined under the NIR mode to locate any extra ICG-stained (E) tissues, which were excised and sent for pathologic confirmation. This technique was tested in 2 steps: infra-pyloric LN dissection (step 1) and review of all stations after proper radical node dissection (step 2). Results: In step 1, 15 patients who underwent laparoscopic pylorus-preserving gastrectomy (LPPG) and 15 patients who underwent laparoscopic distal gastrectomy (LDG) were examined. Seven and 2 E-tissues were obtained during LPPG and LDG, respectively. From the retrieved E-tissues, 1 and 0 tissue obtained during LPPG and LDG, respectively, was confirmed as LN. In step 2, 20 patients were enrolled (13 D1+ dissection and 7 D2 dissection). Six E-tissues were retrieved from 5 patients, and 1 tissue was confirmed as LN in the pathologic review. Overall, 15 E-tissues were detected and removed, and 2 tissues were confirmed as LNs in the pathologic review. Both nodes were from LN station #6, with 1 case each in the LDG and LPPG groups. Conclusions: NIR imaging may provide additional node detection during laparoscopic LN dissection for gastric cancer, especially in the infra-pyloric area.

• Archives of Plastic Surgery
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• 제48권2호
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• pp.239-240
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• 2021

• Archives of Plastic Surgery
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• 제45권2호
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• pp.152-157
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• 2018

Background Intraoperative indocyanine green (ICG) lymphography can effectively detect functioning lymph vessels in edematous limbs. However, it is sometimes difficult to clearly identify their course in later-stage edematous limbs. For this reason, many surgeons rely on experience when they decide where to make the skin incision to locate the lymphatic vessels. The purpose of this study was to elucidate lymphatic vessel flow patterns in healthy upper extremities in a Korean population and to use these findings as a reference for lymphedema treatment. Methods ICG fluorescence lymphography was performed by injecting 1 mL of ICG into the second web space of the hand. After 4 hours, fluorescence images of lymphatic vessels were obtained with a near-infrared camera, and the lymphatic vessels were marked. Three landmarks were designated: the radial styloid process, the mid-portion of the cubital fossa, and the lower border of the deltopectoral groove. A straight line connecting the points was drawn, and the distance between the connected lines and the marked lymphatic vessels was measured at 8 points. Results There were 30 healthy upper extremities (15 right and 15 left). The average course of the main lymph vessels passed $26.0{\pm}11.6mm$ dorsal to the styloid process, $5.7{\pm}40.7mm$ medial to the mid-cubital fossa, and $31.3{\pm}26.1mm$ medial to the three-quarters point of the upper landmark line. Conclusions The main functioning lymphatic vessel follows the course of the cephalic vein at the forearm level, crosses the mid-cubital point, and travels medially toward the mid-axilla.

• Journal of Pharmaceutical Investigation
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• 제22권1호
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• pp.11-21
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• 1992

The effects of colchicine on the plasma elimination and biliary excretion of various organic anions in rats were examined. Elimination of indocyanine green (ICG) or rose bengal (RB) from plasma was significantly delayed when rats were treated with colchicine (3 mg/kg body weight) 3 hr prior to the administration of the dye. On the other hand, disappearance of sulfobromophthalein (BSP) or bromophenol blue (BPB) from plasma was not influenced by colchicine. The plasma disappearance and biliary excretion of organic anions were kinetically analyzed based on a compartment model, in which the deep compartment and the unknown disposition are incorporated. The transfer rate constants of ICG or RB, $k_{23}$ (from the liver to the deep compartment) and $k_{3B}$ (from the deep compartment to the bile), were decreased by colchicine, but those of BSP or BPB were not changed. A mechanism for the decrease in the $k_{23}$ and $k_{3B}$ values for ICG and RB might be explained by a inhibition of colchicine to the intracellular cytoskeleton. The hepatocellular distribution of RB or BPB was then determined. BPB mainly distributed to the cytosolic fraction, but RB distributed to each hepatocyte organelle. Taken together. it was suggested that ICG or RB is transported through hepatocytes into bile with the aid of the cytoskeleton, whereas BSP or BPB is handled by hepatocytes in a different way.

• 대한방사성의약품학회지
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• 제1권1호
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• pp.62-73
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• 2015

We developed an evans blue-indocyanine green-$^{99m}Tc$-human serum albumin conjugate for sentinel lymph node mapping and we describe its unique potential usage for clinical implications. This conjugate has combined the strengths of visible blue dye, near-infrared fluorescence and radioisotope into one single conjugate without any additional weakness/disadvantage. All the components of evans blue-indocyanine green-$^{99m}Tc$-human serum albumin are safe and of low cost, and they have already been clinically used. This conjugate was stable in the serum, it showed a long retention time in the lymphatic system and the lymph nodes showed a much higher signal-to-noise ratio after the conjugate was injected intradermally into the paw of mice. Both the single-photon emission computed tomography and near-infrared fluorescent images of the mice were successfully obtained at the same time as the excised sentinel lymph nodes showed blue color. The visual color, near-infrared fluorescence and gamma ray from this agent could be complementary for each other in all the steps of sentinel lymph node sampling: exploring and planning sentinel lymph node before excision with visualization of the exact sentinel lymph node location during an operation. Therefore, the triple modal agent will possibly be very ideal for sentinel lymph node mapping because of the high signal-to-noise ratio for non-invasive imaging and its complementary multimodal nature, easy preparation and safety. It is promising for clinical applications and it may have great advantages over the traditional single modal methods.