Hepatobiliary surgery guided by a novel fluorescent imaging technique for visualizing hepatic arteries, bile ducts, and liver cancers on color images.

t t i g A fluorescent imaging technique using indocyanine green (ICG) was first introduced for assessing coronary artery bypass graft patency; its use was subsequently extended o visualize lymphatic vessels that need to be anastomosed and to identify sentinel lymph nodes during breast and gastric cancer operations. Recently, the fluorescent imagng technique has also been applied to hepatobiliary opertions, enabling highly sensitive identification of liver ancers and extrahepatic bile ducts. Although the echnique is used by several surgeons in clinical settings in apan, one of the drawbacks of the conventional fluorescent imaging system is that it provides only monochromatic images, which makes it relatively difficult for surgeons to assess the spatial relationships between the fluorescing lesions and the surrounding organs. Here, we describe hepatobiliary procedures using a novel imaging technique that enables visualization of fluorescing liver cancers and/or bile ducts on color images of the surrounding structures in real-time during surgery.