Experimental validation of the technique of fiberoptic fluorescence microscopy for the intraoperative navigation in liver resection

• Applicants: Professor Dr. Hans-Ulrich Kauczor, since 4/2024; Professor Dr. Arianeb Mehrabi; Professor Dr. Eduard Ryschich
• Subject Area: General and Visceral Surgery
• Term: since 2021
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 467355765

Relevance: In the present project, an innovative technique that should substantially improve intraoperative navigation during liver resection, will be analyzed. The technique is based on the new concept for definition of the liver dissection borderline, by which liver segment labelling with indocyanine green, fiber optic fluorescence microscopy and macroscopic imaging are combined. The potential of liver segment labelling using endothelial capture (Endocapt) will additionally be evaluated. The clinical implementation of the above system could potentially lead to a substantial improvement of the intraoperative navigation during the liver resection. It could improve the postoperative complication and tumor recurrence rates and lead to a significant economic effect. Description: Liver resection is one of the most common major surgical procedures in visceral surgery. The typical indications for this operation are malignant and benign liver tumors and liver metastases from other gastrointestinal tumors such as colorectal cancer and pancreatic cancer. The extent of the operative intervention is important for the postoperative outcome and for the development of postoperative complications. Intraoperative surgical orientation during the liver resection (navigation) is carried out using various methods such as the surgical and operative identification of the large blood vessels, ultrasound and the injection of dyes.In the last year, our research group designed a near-infrared(NIR) imaging system that combines the macroscopic visualization and fiberoptic microscopy (FOM). FOM uses a very thin flexible fiber bundle of variable length. The system was tested on a pig liver after segment perfusion with ICG or after anti-CD31-IRDye700DX labelling and shows an excellent visualization of the labelled liver segments. By inserting the fiber optic into the liver, the segment boundary in the depth of the organ can be identified which should indicate the dissection line in advance. Such definition of the dissection borderline in the depth of the liver would simplify and accelerate the surgery and sould have the positive effect on the postoperative outcome and operation costs. Work program: The aim of the project is the experimental validation of the system for combined NIR macro / FOM imaging with intraoperative navigation in a pre-clinical model of liver resection. The work program is designed as step-by-step study and will focus on dye uptake and imaging in the model of isolated pig liver, in vivo liver resection using navigation with macro / FOM imaging in pigs and FOM imaging of human liver resections after labelling.

• DFG Programme: Research Grants
• Ehemalige Antragsteller: Privatdozent Dr. De-Hua Chang, from 1/2023 until 4/2024; Privatdozent Dr. Christof-M. Sommer, until 12/2022