Document Detail

Near-infrared fluorescence imaging of thoracic duct anatomy and function in open surgery and video-assisted thoracic surgery.
MedLine Citation:
PMID:  21477818     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Chylothorax resulting from thoracic duct damage is often difficult to identify and repair. We hypothesized that near-infrared fluorescent light could provide sensitive, real-time, high-resolution intraoperative imaging of thoracic duct anatomy and function.
METHODS: In 16 rats, 4 potential near-infrared fluorescent lymphatic tracers were compared in terms of signal strength and imaging time: indocyanine green, the carboxylic acid of IRDye 800CW (LI-COR, Lincoln, Neb), indocyanine green adsorbed to human serum albumin, and IRDye 800CW conjugated covalently to human serum albumin. Optimal agent was validated in 8 pigs approaching human size (n = 6 by open surgery with FLARE imaging system [Beth Israel Deaconess Medical Center, Boston, Mass] and n = 2 by video-assisted thoracoscopic surgery minimally invasive [m-FLARE] imaging system [Beth Israel Deaconess Medical Center]). Lymphatic tracer injection site, dose, and timing were optimized.
RESULTS: For signal strength, sustained imaging time, and clinical translatability, the best lymphatic tracer was indocyanine green, which is already Food and Drug Administration approved for other indications. In pigs, a simple subcutaneous injection of indocyanine green into lower leg (≥ 36 μg/kg), provided thoracic duct imaging with onset of about 5 minutes after injection, sustained imaging for at least 60 minutes after injection, and signal-to-background ratio of at least 2. With this technology, normal thoracic duct flow, collateral flow, injury models, and repair models could all be observed under direct visualization.
CONCLUSIONS: Near-infrared fluorescent light could provide sensitive, sustained, real-time imaging of thoracic duct anatomy and function during both open and video-assisted thoracoscopic surgery in animal models.
Yoshitomo Ashitate; Eiichi Tanaka; Alan Stockdale; Hak Soo Choi; John V Frangioni
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2011-04-07
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  142     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-20     Completed Date:  2011-08-19     Revised Date:  2014-09-12    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  31-8.e1-2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Chylothorax / diagnosis*,  etiology,  pathology
Diagnostic Imaging / instrumentation,  methods*
Fluorescent Dyes / administration & dosage,  diagnostic use*
Indocyanine Green / administration & dosage,  analogs & derivatives,  diagnostic use*
Infrared Rays / diagnostic use
Injections, Subcutaneous
Monitoring, Intraoperative / instrumentation,  methods*
Rats, Sprague-Dawley
Thoracic Duct / injuries*,  pathology
Thoracic Surgery, Video-Assisted* / adverse effects,  instrumentation
Time Factors
Grant Support
#R01-CA-115296/CA/NCI NIH HHS; R01 CA115296/CA/NCI NIH HHS; R01 CA115296-07/CA/NCI NIH HHS
Reg. No./Substance:
0/Fluorescent Dyes; IX6J1063HV/Indocyanine Green

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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