NIR/ICG – Near-Infrared Fluorescence
Fluorescence Imaging
Your Real-Time Guide for Everyday Use
In endoscopic surgery, detecting structures earlier and differentiating them better is a necessity. The imaging technology has to replace the missing view of the open site. Alongside an optimal image, it is helpful to receive additional information that increases the precision of the surgical technique. This information is supplied, for instance, by NIR/ICG fluorescence imaging – an OPAL1® technology from KARL STORZ.
The use of indocyanine green (ICG) together with light at wavelengths in the near infrared range (NIR) permits visualizing anatomic structures, for instance. KARL STORZ considers fluorescence technology a future standard imaging technique.
IMAGE1 S™ Rubina®– mORe to discover
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- IMAGE1 S™ Rubina®
The new IMAGE1 S™ Rubina® imaging technology from KARL STORZ combines 3D and 4K technology with NIR/ICG fluorescence imaging to support surgeons’ work by supplying high quality information.
Further information on the components in the Rubina® product family is available here.
Customer Feedback
Prof. Dr. med. Dr. habil. Thomas Carus FACS, Elisabeth-Krankenhaus-Thuine, Germany
NIR/ICG Visualization Modes
The Rubina® components offer users various new modes for visualizing the NIR/ICG signal. This includes the overlay of NIR/ICG data onto the standard white light image or alternatively the monochromatic visualization of the infrared signal alone.
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- Source: Prof. Luigi Boni, Policlinico di Milano, Milan, Italy
Overlay
In Overlay mode, the regular white light image is combined with the NIR/ICG data to generate an overlay image.
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- Source: Prof. Massimo Carlini, Rome, Italy
Green or blue – it's up to you
Depending on your preferences and application, the NIR/ICG data can be displayed as a green or blue overlay.
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- Source: Dr. Michael Zünd, Zug Cantonal Hospital, Baar, Switzerland
Intensity Map
Displays the intensity of the NIR/ICG signal using a color scale in an overlay image.
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- Source: Prof. Luigi Boni, Policlinico di Milano, Milan, Italy
Monochromatic
In this mode, the NIR/ICG signal alone is displayed in white on a black background to achieve the greatest possible differentiation.
All-in-One Solutions
Thanks to modular architecture, new 4K, 3D, NIR/ICG, and LED components can be added to the existing IMAGE1 S™ camera platform. The IMAGE1 S™ Rubina® components offer users new options and a series of advantages to support them in their daily routine.
There is mORe to discover
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- The IMAGE1 S™ Rubina® technology for NIR/ICG fluorescence imaging
Rubina® Product Family
TIPCAM®1 Rubina® – The New 4K/3D NIR/ICG Videoendoscope
TIPCAM®1 Rubina® provides surgeons with excellent depth perception. This stereoscopic system offering 3D in 4K quality is particularly helpful when performing activities that require spatial vision. Thanks to the modular system design, existing IMAGE1 S™ 2D systems can be upgraded to 3D. Whether for laparoscopy, gynecology, urology or cardiothoracic surgery – the new TIPCAM®1 Rubina® features a wide range of applications.
- Automatic horizon control for better orientation and handling
- 4K-3D NIR/ICG videoendoscopes with 10 mm diameter as well as 0° and 30° directions of view
- Easy toggle from 3D to 2D
- OPAL1® NIR/ICG visualization modes: Overlay, Monochromatic and Intensity Map
- Easy integration into the IMAGE1 S™ platform
Automatic horizon orientation
Power LED RUBINA™ – The New LED Light Source for White Light and NIR/ICG Applications
Power, efficiency, durability and flexibility are the hallmarks of the POWER LED RUBINA™ cold light source based purely on LED technology. The light source can be used for white light as well as fluorescence applications for displaying NIR/ICG or autofluorescence in the near infrared range. In conjunction with other RUBINA™ components, it allows the use of various new modes for displaying the NIR/ICG signal: A superimposed NIR/ICG signal in the white light image, an intensity display of the NIR/ICG signal as well as a pure near infrared mode in monochromatic color display for clear delineation of structures. Only long-life LEDs are used so no laser protection measures are necessary.
- Laser-free LED light source for white light and excitation of NIR/ICG
- OPAL1® NIR/ICG technology with new functionalities
- Straightforward user interface thanks to intuitive touch screen
- Constant light intensity maintained throughout the entire service life
- Very low volume*
* in comparison to previous models
IMAGE1 S™ 4U Rubina® – The New 4K NIR/ICG Camera Head
IMAGE1 S™ 4U Rubina® combines 4K imaging technology with fluorescence imaging for displaying NIR/ICG or autofluorescence in the near infrared range. The technology features very good image quality as well as new NIR/ICG fluorescence modes. The new modes, e.g., the superimposed NIR/ICG signal in the white light image, provide the user with valuable information. In addition, IMAGE1 S™ Rubina® offers the display intensity of a NIR/ICG signal and a pure near infrared mode in monochromatic color display for the clear delineation of structures.
- Native 4K image resolution with very good image brightness and richness of color and detail
- OPAL1® NIR/ICG technology with new functionalities
- S-Technologies in white light and the overlay modes Overlay and Intensity Map
- Enhanced* NIR/ICG telescopes and new models
- Laser-free LED light source for white light and excitation of NIR/ICG
* in comparison to previous models
Example Applications of NIR/ICG
Visualization of Perfusion
New meta-analysis regarding the use of NIR/ICG in colorectal surgery
Perfusion assessment is important in various medical disciplines. With IMAGE1 S™ Rubina® and ICG administration, ischemic areas, perfusion, and vascular structures can be displayed in real time, thereby enabling the surgeon to respond intraoperatively.
Example applications:
- Rapid perfusion assessment of a planned resection zone as well as of the subsequent anastomosis, e.g., in colon1 or esophageal resection and gastric bypass2
- Display of the cystic artery in cholangiography2
- Visualization of liver segments3 and lung segments4
- Visualization of vessels within and outside of tumor tissue for the improved definition of tumor margins in otorhinolaryngology5
- Multidisciplinary use in laparoscopic, endoscopic, and open surgery
1Koh et al., Fluorescent Angiography Used to Evaluate the Perfusion Status of Anastomosis in Laparoscopic Anterior Resection, 2016
2Boni et al., Clinical Applications of Indocyanine Green (ICG) Enhanced Fluorescence in Laparoscopic Surgery, 2015
3Diana M et al Superselective Intra-arterial Hepatic Injection of Indocyanine Green (ICG) for Fluorescence Image-guided Segmental Positive Staining: Experimental Proof of the Concept, 2017
4Pischik et al., NIR / ICG Fluorescence Imaging in Thoracoscopic Segmentectomy, 2018
5Schmidt et al., Near-Infrared Endoscopy with Indocyanine Green in Otolaryngology, 2016
Bile Visualization
Due to its hepatobiliary excretion, ICG collects in the gallbladder and bile ducts. This allows, for instance, the rapid and easy identification of the biliary anatomy in cholecystectomy.
Example applications:
- Reduced surgical duration with ICG when compared to standard cholangiographies.1 Facilitated differentiation between cystic duct and common bile duct.2
- Visual perceptual illusion is the cause of 97% of bile duct injuries; moreover, 19% of all patients exhibit abnormal anatomic variations of the gallbladder.3
- Display of intraoperative bile leakage with ICG, e.g., following partial hepatectomy.
1Dip et al., Cost analysis and effectiveness comparing the routine use of intraoperative fluorescent cholangiography with fluoroscopic cholangiogram in patients undergoing laparoscopic cholecystectomy, 2014
2Boni et al., NIR/ICG Fluorescence Imaging in Laparoscopic Surgery, Doctor-to-Doctor Manual ENDO-PRESS®, (ISBN 978-3-89756-933-1)
3Dip F., et al., EndoPress Silverbrochure, Fluorescence Cholangiography, 2017
Visualization of Hepatocellular Carcinoma and Metastases
Primary liver tumors are the sixth most common type of cancer worldwide. Metastases to the liver are even more common than primary liver tumors, by a factor of 20.1 IMAGE1 S™ Rubina® in combination with ICG offers many advantages in liver surgery.
- Intraoperative visualization of metastases and hepatocellular carcinoma on or below the liver surface2
- Diagnostics of superficial or near-surface micrometastases down to the millimeter range3
- Easier definition of resection borders4
- Visualization of liver segments
1Cancer in Germany 2011/2012 (10th edition), Robert Koch Institute, Berlin
2Visualization of ICG up to a depth of one centimeter, depending on the tissue composition
3Tummers et al., First experience on laparoscopic near-infrared fluorescence imaging of hepatic uveal melanoma metastases using indocyanine green, 2014
4Boni et al., ICG-Enhanced Fluorescence-Guided Laparoscopic Surgery, Doctor-to-Doctor Manual ENDO-PRESS®, (ISBN 978-3-89756-934-8)
Visualization of the Lymphatic System
The reliable identification of the lymphatic system or the sentinel lymph node represents a challenge in oncological procedures. The use of ICG* in these procedures permits the real-time visualization of the entire lymphatic system draining the tumor. Nuclear medicine imaging can therefore be avoided.1
Example applications:
- Non-radioactive method for lymph node visualization
- Detection rates compare favorably with established methods of lymph node visualization2
- Localization of lymphatic leakages3
- Multidisciplinary use, for instance in gynecology, urology, and general surgery
*The approval status of the drug may vary. Before using it, please determine the status applicable at your hospital or in your country.
1Papadia A. et al., ICG-Enhanced Fluorescence-Guided SLN Mapping in Gynecological Malignancies, Doctor-to-Doctor Manual ENDO-PRESS®, (ISBN 978-3-89756-932-4)
2Imboden et al., A Comparison of Radiocolloid and Indocyanine Green Fluorescence Imaging, Sentinel Lymph Node Mapping in Patients with Cervical Cancer Undergoing Laparoscopic Surgery, 2015
3Papadia A et al. Indocyanine Green Fluorescence Imaging in the Surgical Management of an Iatrogenic Lymphatic Fistula: Description of a Surgical Technique, 2015