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

2021 Fiscal Year Final Research Report

• Project/Area Number: 19K20735
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 90140:Medical technology assessment-related
• Research Institution: Jikei 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
• 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

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.

Free Research Field

消化器外科

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.