Ann Surg Treat Res.  2023 Mar;104(3):144-149. 10.4174/astr.2023.104.3.144.

Laparoscopic fluorescence imaging technique for visualizing biliary structures using sodium fluorescein: the result of a preclinical study in a porcine model

• Kim S
• Lee CM
• Lee Y
• Han HJ
• Song TJ

• KMID: 2539692
• DOI: http://doi.org/10.4174/astr.2023.104.3.144

Abstract

Purpose
Near-infrared fluorescence imaging has been recently applied in the field of hepatobiliary surgery. Our objective was to apply blue-light fluorescence cholangiography during laparoscopic surgery. Therefore, we designed a preclinical study to evaluate the feasibility of using blue-light fluorescence for cholangiography in a porcine model.
Methods
Five millimeters of sodium fluorescein (SF) solution was administered into the gallbladder of 20 male 3-way crossbred (Landrace × Yorkshire × Duroc) pigs in laparoscopic approach. The biliary tree was observed under blue light (a peak wavelength of 450 nm) emitted from a commercialized light-emitting diode (LED) light source (XLS1 extreme, Chammed).
Results
In 18 of 20 porcine models, immediately after SF solution was administered into the gallbladder, it was possible to visualize the biliary tree under blue light emitted from the LED light source.
Conclusion
This study provided a preclinical basis for using blue-light fluorescence cholangiography using SF in laparoscopic surgery. The clinical feasibility of blue-light fluorescence imaging techniques for laparoscopic cholecystectomy remained to be demonstrated.

Keyword

Blue light; Cholangiography; Fluorescence; Sodium fluorescein

Figure

• 

  Fig. 1 The light source for blue-light fluorescence. (A) A commercialized light-emitting diode (LED) light source. (B) The wavelength of the light emitted from LED light source.

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  Fig. 2 The modified laparoscope to provide both white light and blue light. (A) The overview of the modified laparoscope connected to both white-light source and light-emitting diode light source. (B) White light emitted from the modified laparoscope penetrating through a 12-mm trocar. (C) Blue light emitted from the modified laparoscope penetrating through a 12-mm trocar.

• 

  Fig. 3 Visualization of the bile duct. (A) When the white-light source was activated and light-emitting diode (LED) light source was not activated. (B) When we turned off the white-light source and turned on the LED light source, the extrahepatic biliary duct appeared fluorescent under blue light emitted from the LED light source. CD, cystic duct; CBD, common bile duct.

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