Real-time intra-operative biliary imaging using a lightweight infrared coupler and a standard laparoscopic system

Ramon Berguer, MD, David Ferrick, PhD, Vince Sullivan, Vladimir Breytberg, Roger Stern, PhD

LifeGuard Surgical Systems, Stellartech Research Corporation

We describe an infrared common bile duct imaging system that allows the real-time visualization of the extra-hepatic biliary anatomy during laparoscopic cholecystectomy (LC) using existing laparoscopic systems. This technology could reduce or eliminate the 4,000-5,000 intra-operative CBD injuries that occur during LC each year in the U.S. with beneficial impact on patient safety, malpractice costs, operating room time, radiation exposure, and the cost of cholangiography.

The pre-clinical prototype comprises: a 780nm narrow-spectrum infrared light source blended with the standard illumination pathway; a lightweight detachable coupler inserted between the laparoscope and the existing laparoscopic camera; and a small image processing unit. Indocyanine green (ICG) is injected intravenously and excreted into the biliary system after 30 min. The fluorescence from ICG, centered around 835 nm, is transmitted through the laparoscope and is split – via specialized optics in the coupler – into a visible component transmitted to the existing laparoscopic camera, and an IR component which is transmitted to the infrared image processing unit. The visible and IR images can then be viewed simultaneously and in real-time to provide a "live" view of the biliary tree during dissection.

The system has been tested in a pig animal model and provided excellent views of the common hepatic duct, the common bile duct, and the cystic duct 30 minutes after ICG injection. Additionally, bile spillage was immediately detected with the IR camera after a CBD laceration.

Infrared imaging of subsurface tissue structures such as the biliary system can be accomplished using existing laparoscopic systems and a lightweight detachable coupler. Future developments will allow coloration and overlay of the infrared image on the surgical image. Infrared subsurface imaging holds great promise for low-cost real-time surgical navigation in minimally invasive surgery, and could significantly reduce surgical complications and the cost of care.

Session: Poster Presentation

Program Number: ETP032

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