Son Gyung Mo, Park Sang-Ho, Kim Nam Su, Yun Mi Sook, Lee In Young, Kwon Myeong-Sook, Kim Tae Kyun, Lee Eun Hwa, Hwang Eun Jung, Baek Kwang-Ryul
Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea.
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea.
Medicina (Kaunas). 2024 Nov 29;60(12):1966. doi: 10.3390/medicina60121966.
: This study aimed to determine the minimal effective dose of indocyanine green (ICG) required for accurately assessing colonic perfusion during laparoscopic colorectal surgery using a laser-assisted laparoscopic near-infrared (NIR) camera system. : In 15 patients with colorectal cancer undergoing right hemicolectomy, the left branch of the middle colic artery was preserved, and ICG angiography was performed in the transverse colon. To determine the optimal ICG dose, experimental doses of 0.01, 0.02, 0.03, 0.04, and 0.05 mg of ICG per patient's body weight (kg) were administered intravenously in each group. Additionally, a conventional dose of 0.2 mg/kg was administered in the same patients more than 30 min after the initial dose. For quantitative analysis, the fluorescent expression region was extracted, and fluorescence intensity was analyzed using automatic image processing. Analysis accessibility, T, perfusion time ratio, slope, artificial intelligence (AI)-based perfusion pattern analysis, and washout time were measured in 150 detailed regions of interest in each image. : Group 1 (0.01 mg/kg) showed significantly lower accessibility rates for quantitative analysis (48.0%) compared with Groups 2-5 (84.7-100%). The mean slope value in Group 1 was 3.7, which fell below the acceptable threshold (>4) and was significantly lower than that of the other groups ( < 0.001). An acceptable AI-based perfusion pattern was 14.2% in Group 1, significantly lower than in Groups 2-5 (66.4-100%). Washout time was significantly faster with minimal doses compared with conventional doses (39.0 ± 15.8 s vs. 117.5 ± 4.9 s, respectively, < 0.001). : This study supports the use of minimal ICG doses, ranging from 0.02 to 0.05 mg/kg, to optimize repetitive ICG angiography using a laser-assisted laparoscopic NIR camera.
本研究旨在确定使用激光辅助腹腔镜近红外（NIR）摄像系统在腹腔镜结直肠手术中准确评估结肠灌注所需的吲哚菁绿（ICG）最小有效剂量。在15例行右半结肠切除术的结肠癌患者中，保留结肠中动脉左支，并在横结肠进行ICG血管造影。为确定最佳ICG剂量，每组分别静脉注射按患者体重（kg）计算的0.01、0.02、0.03、0.04和0.05 mg ICG的实验剂量。此外，在初始剂量后30多分钟，对同一患者静脉注射0.2 mg/kg的常规剂量。进行定量分析时，提取荧光表达区域，并使用自动图像处理分析荧光强度。在每个图像的150个详细感兴趣区域测量分析可及性、T、灌注时间比、斜率、基于人工智能（AI）的灌注模式分析和洗脱时间。与第2 - 5组（84.7 - 100%）相比，第1组（0.01 mg/kg）的定量分析可及率显著较低（48.0%）。第1组的平均斜率值为3.7，低于可接受阈值（>4），且显著低于其他组（<0.001）。第1组基于AI的可接受灌注模式为14.2%，显著低于第2 - 5组（66.4 - 100%）。与常规剂量相比，最小剂量的洗脱时间明显更快（分别为39.0±15.8秒和117.5±4.9秒，<0.001）。本研究支持使用0.02至0.05 mg/kg的最小ICG剂量，以优化使用激光辅助腹腔镜NIR摄像系统的重复ICG血管造影。
