A Biliary Tract-Specific Fluorescence Image-guided Surgery

Abstract The primary liver cancer including intrahepatic bile duct cancer pose significant global burden of illness with increasing incidence and mortality in US and around the world. Surgery remains the most effective form of treatment. However, surgical complication rates for medium to high complexity hepatectomies persist in 30-40% range even in highly skilled hands and at high volume centers. The critical challenges appear to be attributable to navigating liver parenchymal dissection, where size of resection surface, associated with blood loss and missed bile leaks from the liver parenchyma, and prolonged operative time during dissection pose significant obstacle.In this research, we propose to develop an upgraded laparoscopic imager for deeper biliary-specific fluorescent imaging using a short-wave infrared (SWIR) sensor and high-definition RGB color vision, and to test the utility of our multimodal laparoscopic imaging technique in liver surgery throughout preclinical swine studies. The clear anatomic display of intrahepatic critical structures and functional physiology will make the hepatic dissection safer and more efficient for any liver resection. The goal of this 1-year research is to develop and evaluate the novel biliary-specific fluorescence and laparoscopic vision/display through the following specific aims; Aim1: To develop a formfactor SWIR camera system for fluorescence image-guided laparoscopy; Aim 2: To validate the usefulness of the developed new vision platform in preclinical animal studies.Narrative We propose to examine a tissue-specific fluorescence surgical vision tool that will improve function and outcome of surgical tasks such as complex liver resection surgery. In this research, we will develop a novel laparoscopic vision device with multimodal optical imaging techniques and validate that intraoperative display of unseen anatomic structures can improve the surgical outcomes in preclinical studies.