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Visualization of blood flow dynamics by ICG Fluorescence Method for Improving Outcomes in Laparoscopic Colorectal Cancer Surgery

Research Project

Project/Area Number 19K20735
Research Category

Grant-in-Aid for Early-Career Scientists

Allocation TypeMulti-year Fund
Review Section Basic Section 90140:Medical technology assessment-related
Research InstitutionJikei University School of Medicine

Principal Investigator

Ryu Shunjin  東京慈恵会医科大学, 医学部, 助教 (30833587)

Project Period (FY) 2019-04-01 – 2022-03-31
Project Status Completed (Fiscal Year 2021)
Budget Amount *help
¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
Fiscal Year 2021: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000)
Fiscal Year 2020: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000)
Fiscal Year 2019: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000)
Keywords大腸癌 / 腹腔鏡手術 / ICG / 蛍光 / 手術ナビゲーション / 血流 / 血管 / 蛍光ナビゲーション / 腹腔鏡 / 縫合不全 / 血管ナビゲーション / 血流評価 / 手術 / ICG蛍光
Outline of Research at the Start

大腸癌は増加傾向にあり, 開腹手術から腹腔鏡手術に移行している. 腹腔鏡手術は, 開腹手術と異なる技術を要し難易度が高く習得には時間がかかる.また縫合不全などの合併症も少なくない.
血管に注入したIndocyanine green(ICG)は, 近赤外光を照射すると蛍光を発し, 特殊なカメラを使用する事で血流動態を可視化できる.大腸癌手術では, 吻合腸管の血流低下が縫合不全の原因となる.
本研究は大腸癌について, 腹腔鏡下にICG蛍光法を用いて腸管血流を評価して吻合を行う事で縫合不全を減らすとともに, 血管を蛍光させ視認し易くして手術時間を短縮し安全で確実な手術を目指す.

Outline of Final Research Achievements

The use of Indocyanine green (ICG) helps evaluate intestinal blood flow of anastomoses to avoid leakage, as well as intestinal lymph flow. We reported real-time fluorescence vessel navigation using ICG for identification of artery and vein. Recently, a newly developed near-infrared fluorescent resin also emits fluorescence similar to ICG. We used new devices such as fluorescence clip and fluorescence ureter catheter made with this resin in addition to ICG.
We reported intestinal blood flow evaluation for anastomosis to reduce anastomotic leakage, preoperative fluorescence clip marking to identify tumor location, fluorescence ureteral navigation for locally advanced colorectal cancer and fluorescence vessel navigation of internal iliac artery for Lateral lymph node dissection for laparoscopic fluorescence guided surgery. The efficacy of preoperative fluorescence clip marking was reported for colorectal cancer and gastric cancer.

Academic Significance and Societal Importance of the Research Achievements

腹腔鏡をはじめとする低侵襲手術の適応は拡大し, より複雑で困難な手術に対しても安全な施行が求められている。また大腸癌の腹腔鏡手術の治療成績においては施設間差が指摘されている事も問題である。術後縫合不全を低減するための血流評価をICGで可視化する工夫や、通常は透見されない血管や尿管を蛍光で光らせながら行う蛍光ガイド手術は、手術の難易度を低減し、安全性を向上するメリットが期待される。
このような手術ナビゲーションは, 解剖の十分な知識や多数の手術経験があれば必ずしも必要ではないが,より複雑で高難度な腹腔鏡手術の実践にあたって, また若手外科医の安全な教育の側面に社会的意義があると思われる.

Report

(4 results)
  • 2021 Annual Research Report   Final Research Report ( PDF )
  • 2020 Research-status Report
  • 2019 Research-status Report
  • Research Products

    (3 results)

All 2020 2019

All Journal Article (2 results) (of which Int'l Joint Research: 2 results,  Peer Reviewed: 2 results) Presentation (1 results) (of which Int'l Joint Research: 1 results,  Invited: 1 results)

  • [Journal Article] Evaluation of Anastomosis With ICG Fluorescence Method Using VISERA ELITE2 During Laparoscopic Colorectal Cancer Surgery2020

    • Author(s)
      2)Shunjin Ryu, Katsuhito Suwa, Takahiro Kitagawa, Marie Aizawa, Takurou Ushigome, Tomoyoshi Okamoto, Ken Eto, Katsuhiko Yanaga
    • Journal Title

      Anticancer Research

      Volume: 40 Issue: 1 Pages: 373-377

    • DOI

      10.21873/anticanres.13962

    • Related Report
      2019 Research-status Report
    • Peer Reviewed / Int'l Joint Research
  • [Journal Article] Real-Time Fluorescence Vessel Navigation Using Indocyanine Green During Laparoscopic Colorectal Cancer Surgery2019

    • Author(s)
      2)Shunjin Ryu, Katsuhito Suwa, Takahiro Kitagawa, Marie Aizawa, Takurou Ushigome, Tomoyoshi Okamoto, Ken Eto, Katsuhiko Yanaga
    • Journal Title

      Anticancer Research

      Volume: 39 Issue: 6 Pages: 3009-3013

    • DOI

      10.21873/anticanres.13433

    • Related Report
      2019 Research-status Report
    • Peer Reviewed / Int'l Joint Research
  • [Presentation] Fluorescence Imaging in Colorectal Surgery in Japan2020

    • Author(s)
      Shunjin Ryu, Katsuhito Suwa, Takahiro Kitagawa, Marie Aizawa, Takurou Ushigome, Tomoyoshi Okamoto, Kota Ishida, Yukio Nakabayashi, Ken Eto, Katsuhiko Yanaga
    • Organizer
      7th Annual INTERNATIONAL CONGRESS FOR FLUORESCENCE GUIDED SURGERY
    • Related Report
      2019 Research-status Report
    • Int'l Joint Research / Invited

URL: 

Published: 2019-04-18   Modified: 2023-01-30  

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