Fluorescence cholangiography in open surgery

Although indocyanine green (ICG) fluorescence imaging has long been used in surgery for research purposes, its clinical use began relatively recently and is growing rapidly. ICG fluorescence imaging has advantages in that it: (1) enables the easy, rapid and real-time observation of internal organs using a safe agent, (2) has very high sensitivity, and (3) can identify pathological changes after repeated ICG administration. Therefore, it is widely used in many clinical departments for angiography, lymphangiography, sentinel lymph node visualization and tissue viability detection. The specificity of ICG kinetics makes it possible to acquire diverse information through its time-course distribution into the blood stream, liver parenchyma and biliary tract during abdominal surgery. Indeed, in biliary tract surgery the identification of arteries, veins and bile ducts by taking advantage of the transparency of biological tissues to infrared light, accurate identification of liver segments during intraportal ICG injection, its application in gallbladder cancer surgery based on the identification of the cystic vein perfusion area, utilization of its uptake in hepatocellular carcinoma and metastatic cancer in the liver, and high-sensitivity visualization of bile leakage during hepatectomy have been reported. In addition, ICG imaging has been performed during laparoscopy, making it a very useful technique in abdominal and laparoscopic surgeries. This technology is expected to be further utilized and advanced, and to contribute to clinical practice. This chapter describes the application of ICG fluorescence-based cholangiography to abdominal open surgery.