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Real 3D approach vs 2D camera with and without real-time near-infrared imaging with indocyanine green for detection of endometriosis: a case-control study
摘要： Introduction: The complete surgical removal of endometriosis lesions is not always feasible because some implants may be very small or hidden. The use of intra-operative near-infrared radiation (NIR) imaging after intravenous injection of indocyanine green (ICG) coupled with robotic technical advances, including tridimensional and high-resolution vision, might improve detection rates. Material and methods: This is a retrospective, multicenter case-control study (Canadian Task Force classification II-2) on medical records of women with endometriosis that submitted to surgery at the Catholic University of Rome (controls) and the University of Bologna (Cases) between January, 2016, and March, 2018. Surgical and post-surgical data from the procedures were collected. We compared the visual detection rate of endometriotic lesions using near-infrared radiation imaging after intravenous injection of indocyanine green (NIR-ICG) in Real 3D (Cases) with the 2D Camera approach (Controls) in symptomatic women with pelvic endometriosis. Results: Twenty cases were matched as closely as possible with 27 controls. The suspected lesions identified both with the WL and the NIR-ICG approach were 116 and 70 in the Controls (2D) and Cases (3D), respectively. Among them, 16 of 116 controls (13.8%) and 12 of 70 cases (17.1%) were identified using only NIR-ICG imaging and collected as occult lesions (p=0.536). The overall NIR-ICG lesion identification showed a positive predictive value of 97.8%, negative predictive value of 82.3%, sensitivity of 82.0%, and specificity of 97.9% for the Control group, and a positive predictive value of 100%, negative predictive value of 97.1%, sensitivity of 97.1%, and specificity of 100% for the Cases group, confirming that NIR-ICG imaging is a good diagnostic and screening test (p=0.643 and p=0.791, according to the Cohen kappa tests, respectively for the laparoscopic and robotic groups). Conclusions: The few differences observed did not seem to be clinically relevant, thus making the two procedures comparable in terms of the ability to visually detect endometriotic lesions. Further prospective trials are needed to confirm our results.
关键词： near-infrared radiation,endometriosis,endometriosis surgical treatment,indocyanine green,minimally invasive surgery
更新于2025-09-19 17:13:59
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Near-Infrared Imaging with Second-Window Indocyanine Green in Newly Diagnosed High-Grade Gliomas Predicts Gadolinium Enhancement on Postoperative Magnetic Resonance Imaging
摘要： Purpose: Intraoperative molecular imaging with tumor-targeting fluorophores offers real-time detection of neoplastic tissue. The second window indocyanine green (SWIG) technique relies on passive accumulation of indocyanine green (ICG), a near-infrared fluorophore, in neoplastic tissues. In this study, we explore the ability of SWIG to detect neoplastic tissue and to predict postoperative magnetic resonance imaging (MRI) findings intraoperatively. Procedures: Retrospective data were collected from 36 patients with primary high-grade gliomas (HGG) enrolled as part of a larger trial between October 2014 and October 2018. Patients received systemic ICG infusions at 2.5–5 mg/kg 24 h preoperatively. Near-infrared fluorescence was recorded throughout the case and from biopsy specimens. The presence/location of residual SWIG signal after resection was compared to the presence/location of residual gadolinium enhancement on postoperative MRI. The extent of resection was not changed based on near-infrared imaging. Results: All 36 lesions demonstrated strong near-infrared fluorescence (signal-to-background = 6.8 ± 2.2) and 100 % of tumors reaching the cortex were visualized before durotomy. In 78 biopsy specimens, near-infrared imaging demonstrated higher sensitivity and accuracy than white light for diagnosing neoplastic tissue intraoperatively. Furthermore, near-infrared imaging predicted gadolinium enhancement on postoperative MRI with 91 % accuracy, with visualization of residual enhancement as small as 0.3 cm3. Patients with no residual near-infrared signal after resection were significantly more likely to have complete resection on postoperative MRI (p value G 0.0001). Conclusions: Intraoperative imaging with SWIG demonstrates highly sensitive detection of HGG tissue in real time. Furthermore, post-resection near-infrared imaging correlates with postoperative MRI. Overall, our findings suggest that SWIG can provide surgeons with MRI-like results in real time, potentially increasing resection rates.
关键词： Intraoperative MRI,Postoperative MRI,Indocyanine green,Near-infrared imaging,High-grade gliomas
更新于2025-09-16 10:30:52
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Real-time indocyanine green fluorescent angiography in laparoscopic sigmoid vaginoplasty to assess perfusion of the pedicled sigmoid segment
摘要： To assess the feasibility of intraoperative use of indocyanine green (ICG) ?uorescent angiography in laparoscopic intestinal vaginoplasty to determine intestinal segment perfusion and viability. Design: Intestinal vaginoplasty may be performed as a vaginal (re)construction procedure. During surgery, a pedicled intestinal segment is transferred caudally to line the neovaginal cavity. Most commonly, a sigmoid or ileal segment is used. In obtaining adequate mobility of the segment, arterial structures sometimes have to be sacri?ced, with possible detrimental effects on segment perfusion and subsequently viability. ICG may be used as an aid to assess segment perfusion. We present a case series of six consecutive patients who underwent intestinal vaginoplasty with intraoperative use of ICG. Setting: Tertiary university hospital. Patient(s): Six transgender women undergoing laparoscopic sigmoid vaginoplasty with intraoperative use of ICG from October 2017 to October 2018. Intervention(s): Intraoperative use of ICG in laparoscopic sigmoid vaginoplasty to determine sigmoid segment perfusion and viability. Main Outcome Measure(s): Value and feasibility of ICG in this reconstructive procedure. Result(s): Intraoperative use of ICG demonstrated segment viability in ?ve patients. In one patient, vascularization of the segment was deemed to be inadequate and reconstruction was aborted. Conclusions: ICG ?uorescent angiography may be used intraoperatively to assess perfusion of the pedicled sigmoid segment during sigmoid vaginoplasty.
关键词： sex reassignment procedures,reconstructive surgical procedures,Laparoscopic surgery,sigmoid vaginoplasty,indocyanine green
更新于2025-09-16 10:30:52
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Clinical outcomes of adjunctive indocyanine green-diode lasers therapy for treating refractory periodontitis: A randomized controlled trial with in?vitro assessment
摘要： Background/purpose: It is still challengeable to treat periodontal pockets refractory to mechanical debridement. This study is to evaluate the potential of indocyanine green (ICG)-diode laser-based photothermal therapy (PTT) for solving this dilemma. Methods: Bone marrow-derived mesenchymal stem cells (BMSCs) and periodontal ligament cells (PDLCs) were incubated with phosphate-buffered saline, chlorhexidine, or ICG, non-irradiated or irradiated with 810-nm diode lasers, and the cell viability was evaluated. Patients with teeth refractory to mechanical periodontal debridement on different quadrants were recruited. At baseline (T0), all examined teeth received scaling and root planing, and those on the test quadrant (PTT group) received ICG-diode laser treatment. The outcome was evaluated using clinical parameters and cytokines in the gingival crevicular fluids at 4e6 weeks (T1) and 6 months (T2). Results: In ICG-treated cultures, the viability of BMSCs and PDLCs was recovered on day 4, and laser irradiation inhibited the metabolic activities of BMSCs. 22 patients with 30 control teeth and 35 PTT-treated teeth were examined. All examined teeth showed modest reductions in probing pocket depth (PPD), clinical attachment loss (CAL), bleeding upon probing (BOP), and plaque score at T1 and T2 and significant reductions in IL-1b and MMP-8 at T2. Compared with controls, BOP was reduced more prominently, IL-1b and MMP-8 were significantly lower, and reductions in PPD and CAL were slightly greater in the PTT group at T1 (0.05e0.19 mm). Conclusion: ICG-diode laser-based PTT is compatible to periodontium and assists in faster resolution of gingival inflammation in periodontal pockets refractory to mechanical debridement.
关键词： Cytokines,Indocyanine green,Photochemotherapy,Periodontitis
更新于2025-09-16 10:30:52
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Liposome-Templated Indocyanine Green J- Aggregates for <i>In Vivo</i> Near Infrared Imaging and Stable Photothermal Heating
摘要： Indocyanine green (ICG) is an FDA-approved near-infrared fluorescent dye that has been used in optical imaging and photothermal therapy. Its rapid in vivo clearance and photo-degradation have limited its application. ICG pharmacokinetics and biodistribution have been improved via liposomal encapsulation, while its photothermal stability has been enhanced by ICG J-aggregate (IJA) formation. In the present work, we report a simple approach to engineer a nano-sized, highly stable IJA liposomal formulation. Our results showed that lipid film hydration and extrusion method led to efficient IJA formation in rigid DSPC liposomes, as supported by molecular dynamics modeling. The engineered DSPC-IJA formulation was nano-sized, and with spectroscopic and photothermal properties comparable to free IJA. Promisingly, DSPC-IJA exhibited high fluorescence, which enabled its in vivo tracking, showing prolonged blood circulation and significantly higher tumor fluorescence signals, compared to free ICG and IJA. Furthermore, DSPC-IJA demonstrated high photo-stability in vivo after multiple cycles of 808 nm laser irradiation. Finally, doxorubicin was loaded into liposomal IJA to utilize the co-delivery capabilities of liposomes. In conclusion, with both liposomes and ICG being clinically approved, our novel liposomal IJA could offer a clinically relevant theranostic platform enabling multimodal imaging and combinatory chemo- and photothermal cancer therapy.
关键词： liposomes,J-aggregates,indocyanine green,theranostics,photothermal therapy
更新于2025-09-16 10:30:52
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Near-infrared Fluorescence Imaging with Indocyanine Green in Robot-assisted Partial Nephrectomy: Pooled Analysis of Comparative Studies
摘要： Context: The use of near-infrared fluorescence (NIRF) imaging was described to facilitate selective clamping during robot-assisted partial nephrectomy (RAPN). Objective: To perform a systematic review and cumulative analysis of available studies comparing the outcomes of RAPN with or without use of this technology (NIRF). Evidence acquisition: A systematic review of the literature was performed to identify relevant studies up to December 2018 through PubMed and EMBASE databases. A meta-analysis was conducted with the RevMan 5.3 software. Evidence synthesis: Six comparative studies were identi?ed. Overall, 369 cases were included for the analysis (171 NIRF-RAPN and 198 standard RAPN). No signi?cant difference was identi?ed between groups in baseline characteristics, operating time, and estimated blood loss; however, a shorter clamping time was recorded for the NIRF-RAPN group. Functional outcomes revealed higher overall estimated glomerular ?ltration rate (eGFR) values in the NIRF-RAPN group at short-term (1–3 mo) postoperative follow-up (weighted mean difference [WMD]: 9.26 ml/min; 95% con?dence interval [CI]: 6.46, 12.06; p < 0.001). In two studies, a renal scan-based assessment of split eGFR was available, and pooled analysis revealed higher split eGFR for NIRF-RAPN (WMD: 7.91 ml/min; 95% CI: 4.26, 11.56; p < 0.001), and lower % between preoperative and 1-mo eGFR (WMD: ?7.84%; 95% CI: ?8.85, ?6.83; p < 0.00001). Conclusions: Current evidence regarding the use of NIRF-guided selective clamping during RAPN is based on a limited number of studies from high-volume institutions. Notwithstanding these limitations, NIRF-RAPN can be safely performed, and it might offer better short-term renal functional outcomes. It remains to be determined whether this can ultimately translate into a clinical bene?t for patients undergoing RAPN, especially in the long term.
关键词： Robotic surgery,Indocyanine green,Near-infrared fluorescence,Partial nephrectomy
更新于2025-09-12 10:27:22
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New Perspectives in Surgical Marking Since the Advent of Infrared Laser Angiography
摘要： This study investigates the utility of common surgical dyes under direct visualization and infrared laser angiography. Pigments affecting light within the visual (λ = 400–700 nm) and infrared (λ = 700–1000 nm) spectra were placed on subjects spanning the Fitzpatrick scale. Photometric properties of these pigments were assessed under direct visualization and infrared laser angiography. Among patients of various Fitzpatrick classifications, black ink pigment and pigment within the violet spectrum (λ = 380–450 nm) were most distinguishable under direct visualization. Colored inks, gentian violet and methylene blue dyes, were not visualized under infrared laser angiography. Black permanent ink appeared under both direct visualization and infrared laser angiography. Indocyanine green suspended in ethyl alcohol and applied to skin as a marking pen appeared clear under direct visualization and was detectable under infrared laser angiography. Black permanent marking ink allows visualization of surgical markings under infrared laser angiography, whereas gentian violet and methylene blue did not interfere with infrared visualization. Indocyanine green suspended in ethyl alcohol is a contemporary marking pen that may be used to outline anatomical surface landmarks under infrared laser angiography.
关键词： dye,methylene blue,skin marking,surgical marking,infrared laser angiography,marking pen,indocyanine green,gentian violet,surgical planning,ink
更新于2025-09-12 10:27:22
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Skin and subcutaneous fat morphology alterations under the LED or laser treatment in rats in vivo
摘要： The main objective of this work is to quantify the dynamic/photothermal treatment by using visible LED and NIR laser irradiation through the skin of subcutaneous fat in vivo followed up by tissue sampling and histology. The optical method may provide reduction of regional or site-specific accumulations of abdominal or subcutaneous adipose tissue precisely and least-invasively by inducing cell apoptosis and controlled necrosis of fat tissue. As photo-dynamic/photothermal adipose tissue sensitizers Brilliant Green (BG) or Indocyanine Green (ICG) dyes were injected subcutaneously in rats. The CW LED device (625 nm) or CW diode laser (808 nm) were used as light sources, respectively. Biopsies of skin together with subcutaneous tissues were taken for histology. The combined action BG-staining and LED-irradiation (BG + LED) or ICG-staining and NIR-laser irradiation (ICG + NIR) causes pronounced signs of damage of adipose tissue characterized by a strong stretching, thinning, folding and undulating of cell membranes and appearance of necrotic areas. As a posttreatment after 14 days only connective tissue was observed at the site of necrotic areas. The data obtained are important for safe light treatment of site-specific fat accumulations, including cellulite. This work provides a basis for the development of fat lipolysis technologies and to move them to clinical applications.
关键词： visible light,laser,optical microscopy,fat morphology,skin,subcutaneous adipose tissue,photodynamic and photothermal treatment,LED,Brilliant Green,NIR,Indocyanine Green (ICG)
更新于2025-09-11 14:15:04
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Evaluation of the Intraoperative Blood Flow of Pedicled Perforator Flaps Using Indocyanine Green-fluorescence Angiography
摘要： Background: Although indocyanine-green fluorescence angiography (ICG-FA) has been established as a useful tool to assess perfusion in free tissue transfer, only few studies have applied this modality to pedicled perforator flaps. As both volume and reach of pedicled perforator flaps are limited and tip necrosis often equals complete flap failure, ICG-FA may help to detect hypoperfusion in pedicled flaps. Methods: In 5 patients, soft tissue reconstruction was achieved with pedicled perforator flaps. ICG-FA was utilized intraoperatively to visualize flap perfusion. Results: Three pedicled anterolateral thigh flap flaps and 2 propeller flaps were transferred. ICG-FA detected hypoperfusion in 2 flaps. No flap loss occurred; in 2 cases, prolonged wound healing was encountered. Conclusions: ICG-FA confirmed clinical findings and reliably detected tissue areas with hypoperfusion. A clear cut-off point between nonvital tissue and such that stabilized in the following clinical course could not be found. ICG-FA is a promising technology which could also be used in pedicled perforator flaps.
关键词： flap perfusion,soft tissue reconstruction,pedicled perforator flaps,indocyanine-green fluorescence angiography
更新于2025-09-11 14:15:04
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Clinical application of indocyanine green-fluorescence imaging during hepatectomy
摘要： In hepatobiliary surgery, the fluorescence and bile excretion of indocyanine green (ICG) can be used for real-time visualization of biological structure. Fluorescence cholangiography is used to obtain fluorescence images of the bile ducts following intrabiliary injection of 0.025?0.5 mg/mL ICG or intravenous injection of 2.5 mg ICG. Recently, the latter technique has been used in laparoscopic/robotic cholecystectomy. Intraoperative fluorescence imaging can be used to identify subcapsular hepatic tumors. Primary and secondary hepatic malignancy can be identified by intraoperative fluorescence imaging using preoperative intravenous injection of ICG through biliary excretion disorders that exist in cancerous tissues of hepatocellular carcinoma (HCC) and in non-cancerous hepatic parenchyma around adenocarcinoma foci. Intraoperative fluorescence imaging may help detect tumors to be removed, especially during laparoscopic hepatectomy, in which visual inspection and palpation are limited, compared with open surgery. Fluorescence imaging can also be used to identify hepatic segments. Boundaries of hepatic segments can be visualized following injection of 0.25?2.5 mg/mL ICG into the portal veins or by intravenous injection of 2.5 mg ICG following closure of the proximal portal pedicle toward hepatic regions to be removed. These techniques enable identification of hepatic segments before hepatectomy and during parenchymal transection for anatomic resection. Advances in imaging systems will increase the use of fluorescence imaging as an intraoperative navigation tool that can enhance the safety and accuracy of open and laparoscopic/robotic hepatobiliary surgery.
关键词： liver resection,colorectal liver metastasis (CRLM),Indocyanine green (ICG),hepatocellular carcinoma (HCC),fluorescence imaging,intraoperative cholangiography
更新于2025-09-11 14:12:44