Application of the HyperEye Medical System for endoscopic low anterior resection

Michiya Kobayashi, MD, PhD, Takayuki Sato, MD, PhD, Takeki Sugimoto, MD, PhD, Ken Okamoto, MD, PhD, Daisuke Nakamura, Ken Dabanaka, MD, PhD, Tsutomu Namikawa, MD, PhD, Kazuhiro Hanazakki, MD, PhD

Kochi Medical School

INTRODUCTION
We developed a new imaging system (HyperEye Medical System [HEMS]; MIZUHO, Tokyo, Japan) for the simultaneous capture of near-infrared (NIR) indocyanine green (ICG) fluorescence and visible light rays through a unique highly sensitive charge-coupled device (CCD) sensor coated with arrays of red-, green-, blue-, and NIR-specific filters. Unlike multiple-sensor systems, HEMS enables real-time color NIR imaging during ICG fluorescence-guided endoscopic surgery without the need for special video data processors to superimpose NIR images on color images. We used this system to monitor blood supply to the proximal colon during laparoscopic-assisted low anterior resection.

METHODS AND PROCEDURE
After lymph node dissection and mobilization of the sigmoid colon and rectum, the rectum was transected with a linear stapler. The proximal colon was removed through a small laparotomy, and 5 mL (0.5 mg/mL) ICG solution was injected intravenously. ICG fluorescence was then detected using HEMS.

RESULTS
Approximately 20 s after ICG injection, HEMS clearly demonstrated the arterial phase of the proximal colon, with the capillary phase seen approximately 60 s after injection. After confirmation of a sufficient blood supply to the proximal colon, an anastomosis was created using a circular stapler and the double-stapling technique.

CONCLUSIONS
Using HEMS, we were able to visualize ICG fluorescence at sufficient resolution simultaneously with the surgical field under regular light. Moreover, using HEMS to check the blood supply to the stump of the proximal colon takes only few minutes and does not require any special equipment.

Session: Poster Presentation

Program Number: P378