• Medical Lasers
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• 제10권3호
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• pp.123-131
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• 2021

Optical imaging modalities with properties of real-time, non-invasive, in vivo, and high resolution for image-guided surgery have been widely studied. In this review, we introduce two optical imaging systems, that could be the core of image-guided surgery and introduce the system configuration, implementation, and operation methods. First, we introduce the optical coherence tomography (OCT) system implemented by our research group. This system is implemented based on a swept-source, and the system has an axial resolution of 11 ㎛ and a lateral resolution of 22 ㎛. Second, we introduce a fluorescence imaging system. The fluorescence imaging system was implemented based on the absorption and fluorescence wavelength of indocyanine green (ICG), with a light-emitting diode (LED) light source. To confirm the performance of the two imaging systems, human malignant melanoma cells were injected into BALB/c nude mice to create a xenograft model and using this, OCT images of cancer and pathological slide images were compared. In addition, in a mouse model, an intravenous injection of indocyanine green was used with a fluorescence imaging system to detect real-time images moving along blood vessels and to detect sentinel lymph nodes, which could be very important for cancer staging. Finally, polarization-sensitive OCT to find the boundaries of cancer in real-time and real-time image-guided surgery using a developed contrast agent and fluorescence imaging system were introduced.

• Current Optics and Photonics
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• 제5권5호
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• pp.554-561
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• 2021

Indocyanine green (ICG) is a cyanine dye that has been used in medical diagnostics based on fluorescence imaging, and in medical therapy based on the photothermal effect. It is important to systematically understand the photothermal effect and fluorescence characteristics of ICG simultaneously. By varying a number of conditions such as laser power density, laser irradiation wavelength, concentration of ICG solution, and exposure time of laser irradiation, the intensity properties of fluorescence and the temperature change induced by the photothermal effect are measured simultaneously using a charge-coupled-device camera and a thermal-imaging camera. The optimal conditions for maximizing the photothermal effect are determined, while maintaining a relatively long lifetime and high efficiency of the fluorescence for fluorescence imaging. When the concentration of ICG is approximately 50 ㎍/ml and the laser power density exceeds 1.5 W/cm², the fluorescence lifetime is the longest and the temperature induced by the photothermal effect rapidly increases, exceeding the critical temperature sufficient to damage human cells and tissues. The findings provide useful insight into the realization of effective photothermal therapy, while also specifying the site to be treated and enabling real-time treatment monitoring.

• Journal of Korean Neurosurgical Society
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• 제65권4호
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• pp.572-581
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• 2022

Objective : Compared to microscopes, exoscopes have advantages in field-depth, ergonomics, and educational value. Exoscopes are especially well-poised for adaptation into fluorescence-guided surgery (FGS) due to their excitation source, light path, and image processing capabilities. We evaluated the feasibility of near-infrared FGS using a 3-dimensional (3D), 4 K exoscope with near-infrared fluorescence imaging capability. We then compared it to the most sensitive, commercially-available near-infrared exoscope system (3D and 960 p). In-vitro and intraoperative comparisons were performed. Methods : Serial dilutions of indocyanine-green (1-2000 ㎍/mL) were imaged with the 3D, 4 K Olympus Orbeye (system 1) and the 3D, 960 p VisionSense Iridium (system 2). Near-infrared sensitivity was calculated using signal-to-background ratios (SBRs). In addition, three patients with brain tumors were administered indocyanine-green and imaged with system 1, with two also imaged with system 2 for comparison. Results : Systems 1 and 2 detected near-infrared fluorescence from indocyanine green concentrations of >250 ㎍/L and >31.3 ㎍/L, respectively. Intraoperatively, system 1 visualized strong near-infrared fluorescence from two, strongly gadolinium-enhancing meningiomas (SBR=2.4, 1.7). The high-resolution, bright images were sufficient for the surgeon to appreciate the underlying anatomy in the near-infrared mode. However, system 1 was not able to visualize fluorescence from a weakly-enhancing intraparenchymal metastasis. In contrast, system 2 successfully visualized both the meningioma and the metastasis but lacked high resolution stereopsis. Conclusion : Three-dimensional exoscope systems provide an alternative visualization platform for both standard microsurgery and near-infrared fluorescent guided surgery. However, when tumor fluorescence is weak (i.e., low fluorophore uptake, deep tumors), highly sensitive near-infrared visualization systems may be required.

• 한국임상수의학회지
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• 제39권6호
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• pp.395-399
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• 2022

A 6-year-old spayed, female golden retriever dog was presented with a skin mass on the dorsal region of the right carpus. The cytology result of the region revealed characteristics of mast cell tumors (MCTs). Short wave-infrared fluorescence-guided surgery using Indocyanine green (ICG) was performed to determine the surgical margin of the tumor. ICG was injected intravenously 24 hours before the surgery and the patient was hospitalized and carefully monitored. During the surgery, ICG fluorescence-based surgery was performed to identify the tumor and the surgical margin. The tumor was visible, and the skin mass was resected using NIR device for the guidance of the surgical margin of the tumor. Once the resection was complete, the surgical site was again inspected with SWIR fluorescence imaging to identify residual tumor cells. The resected tumor, using ICG navigation, was classified as low-grade cutaneous MCT and the margin was complete on the histopathological result. We report herein a case of resection of a cutaneous MCT in a dog using SWIR fluorescence imaging ICG which can be potentially used for the identification of tumors and evaluation of the surgical margin for complete resection.

• 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.

• Journal of Chest Surgery
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• 제53권4호
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• pp.178-183
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• 2020

During esophagectomy and esophagogastrostomy, the prediction of anastomotic leakage relies on the operating surgeon's tactile or visual diagnosis. Therefore, anastomotic leaks are relatively unpredictable, and new intraoperative evaluation methods or tools are essential. A fluorescence imaging system enables visualization over a wide region of interest, and provides intuitive information on perfusion intraoperatively. Surgeons can choose the best anastomotic site of the gastric tube based on fluorescence images in real time during surgery. This technology provides better surgical outcomes when used with an optimal injection dose and timing of indocyanine green.

• Journal of Korean Neurosurgical Society
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• 제58권6호
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• pp.513-517
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• 2015

Objective : Microscopic indocyanine green (ICG) angiography is useful for identifying the completeness of aneurysm clipping and the preservation of parent arteries and small perforators. Neuroendoscopy is helpful for visualizing structures beyond the straight line of the microscopic view. We evaluated our prototype of endoscopic ICG fluorescence angiography in swine, which we developed in order to combine the merits of microscopic ICG angiography and endoscopy. Methods : Our endoscopic ICG system consists of a camera, a light source, a display and software. This system can simultaneously display real-time visible and near infrared fluorescence imaging on the same monitor. A commercially available endoscope was used, which was 4 mm in diameter and had an angle of $30^{\circ}$. A male crossbred swine was used. Results : Under general anesthesia, a small craniotomy was performed and the brain surface of the swine was exposed. ICG was injected via the ear vein with a bolus dose of 0.3 mg/kg. Visible and ICG fluorescence images of cortical vessels were simultaneously observed on the display monitor at high resolution. The real-time merging of the visible and fluorescent images corresponded well. Conclusion : Simultaneous visible color and ICG fluorescent imaging of the cortical vessels in the swine brain was satisfactory. Technical improvement and clinical implication are expected.

• Journal of Gastric Cancer
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• 제17권2호
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• pp.145-153
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• 2017

Purpose: Identification of the infrapyloric artery (IPA) type is a key component of pylorus-preserving gastrectomy. As the indocyanine green (ICG) fluorescence technique is known to help visualize blood vessels and flow during reconstruction, we speculated that this emerging technique would be helpful in identifying the IPA type. Materials and Methods: From August 2015 to February 2016, 20 patients who underwent robotic or laparoscopic gastrectomy were prospectively enrolled. After intravenous injection of approximately 3 mL of ICG (2.5 mg/mL), a near-infrared fluorescence apparatus was applied. The identified shape of the IPA was confirmed by examining the actual anatomy following infrapyloric dissection. Results: The mean interval time between ICG injection and visualization of the artery was 22.2 seconds (range, 14-30 seconds), and the mean duration of the arterial phase was 16.1 seconds (range, 9-30 seconds). The overall positive predictive value (PPV) of ICG fluorescence in identifying the IPA type was 80% (16/20). The IPA type was incorrectly predicted in four patients, all of whom were obese with a body mass index (BMI) of more than $25kg/m^2$. Conclusions: Our preliminary results indicate that intraoperative vascular imaging using the ICG fluorescence technique may be helpful for robotic or laparoscopic pylorus-preserving gastrectomy.

• 대한의용생체공학회:의공학회지
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• 제36권1호
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• pp.16-21
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• 2015

Indocyanine green(ICG) and 5-aminolevulinic acid(5-ALA) have been widely used to mark blood vessels or tumors. However, fluorescent dye detection systems were designed to use one type of dyes only. In this study, we proposed a detection system capable of detecting Indocyanine green and 5-aminolevulinic acid. Multiple filters and light sources are integrated into a single system. In this study, we performed analysis of fluorescent dyes and configured a detection system. During the analysis, it was found that Indocyanine green and 5-aminolevulinic acid have the maximum intensity at $40{\mu}M$. We designed light source for fluorescent dyes and conducted compatibility test using a commercial surgical microscope. The fluorescent dye detection system was configured based on the experimental results. The developed system successfully detects Indocyanine green and 5-aminolevulinic acid. Therefore, more efficient surgical operations can be achieved using both fluorescent dyes at the same time. We expect that the developed system can increase the survival rate of patients.

• 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.