Knowing the exact location of gastrointestinal tumors both preoperatively and intraoperatively is essential for planning and performing laparoscopic surgery. Different techniques have been introduced to ascertain tumor locations during surgery, but none of these are fully satisfactory at establishing the minimum margins for organ resection while retaining curability. A new, non-blurring tissue marker, detectable by both X-ray computed tomography (CT) and near-infrared (NIR) fluorescence laparoscopy, has been developed, and we here examine its utility using an animal model.
Liposomes, comprised phospholipids and an NIR fluorescent dye (an indocyanine green derivative), and emulsions, consisting of phospholipids and oily radiographic contrast medium, were combined with polyglycerol-polyricinoleate to form giant cluster-like vesicles. This vesicular dispersion (300 μl) was administered into the porcine gastric submucosa using a gastroendoscope, and the detectability of the marker was examined using X-ray CT and NIR fluorescence laparoscopy.
One hour after the administration of the vesicular dispersion, X-ray CT identified four individual injection sites, each at a 1-cm radius of a metal hemostasis clip. NIR fluorescence laparoscopy detected individual fluorescent spots 18 hours after the administration of the vesicular dispersion.
We anticipate that this newly developed tissue marker will contribute to the preoperative simulation of laparoscopic gastrointestinal cancer surgery and its intraoperative navigation.
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This study was supported by grants from the Ministry of Education, Culture, Sports, Science and Technology of Japan (Grant Nos.: 21591693, 24591933 and 23750078), and a grant from the Japan Science and Technology Agency (Grant No.: 231Z04070).
Hideki Hayashi, Taro Toyota, Shoichi Goto, Aki Ooishi, Tao Gao, Lau Bik Ee, Hirosuke Hatayama, Tomonori Nomoto, Masanori Fujinami, and Hisahiro Matsubara have no conflicts of interests or financial ties to disclose.
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Hayashi, H., Toyota, T., Goto, S. et al. Development of a non-blurring, dual-imaging tissue marker for gastrointestinal tumor localization. Surg Endosc 29, 1445–1451 (2015). https://doi.org/10.1007/s00464-014-3822-1
- Indocyanine green
- Near-infrared fluorescent dye
- Giant vesicle