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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

IMAGE1 S™ Rubina
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.

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.

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.

Green or blue – source: Prof. Massimo Carlini, Rome, Italy
Source: Prof. Massimo Carlini, Rome, Italy

Green or blue – you decide

Depending on your preferences and application, the NIR/ICG data can be displayed as a green or blue overlay.

Intensity Map – source: Dr. Michael Zünd, Baar, Switzerland
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.

Monochromatic mode – source: Prof. Luigi Boni, Policlinico di Milano, Milan, Italy
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.

  • Native 4K resolution
  • Excellent image quality in both white light and the NIR/ICG modes
  • Natural color rendering
  • S-Technologies in white light and in combination with the overlay modes
  • 3D technology in 4K
  • Improved 3D image quality
  • Autoclavable 3D/2D video endoscopes
  • Automatic horizon control

  • OPAL1® NIR/ICG technology
  • Overlay with NIR/ICG displayed in green or blue
  • Intensity Map for displaying signal intensity in the overlay image
  • Monochromatic for the NIR/ICG signal alone
  • New and optimized NIR/ICG telescopes
  • Laser-free LED light source for white light and NIR/ICG
  • Excitation of ICG and autofluorescence in the near infrared
  • Durability and constant light intensity
  • Simple handling thanks to touch display and footswitch

There is mORe to discover

4K, 3D, LED, and NIR/ICG combined in a single technology
The IMAGE1 S™ Rubina technology for NIR/ICG fluorescence imaging

Example Applications of NIR/ICG

Visualization of Perfusion

Perfusion assessment is important in various medical disciplines. With NIR/ICG technology and the administration of ICG, ischemic areas can be displayed in real time more easily and efficiently, or perfusion can be examined, for instance in anastomoses. This enables the surgeon to take intraoperative action.

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.
  • Perfusion assessment of flap plasty in open surgery
  • Visualization of liver segments3
  • 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

Visualization of the Biliary Tree Anatomy

Due to its hepatobiliary excretion, ICG collects in the gallbladder and bile ducts. This allows the rapid and reliable identification of the biliary anatomy, for instance 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
  • 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., ICG-Enhanced Fluorescence-Guided Laparoscopic Surgery, Doctor-to-Doctor Manual ENDO-PRESS®, (ISBN 978-3-89756-934-8)

Visualization of Hepatocellular Carcinoma and Metastases

Primary liver tumors are the sixth most common type of cancer worldwide, and metastases to the liver are even 20 times more common than primary liver tumors.1 For liver surgery, NIR/ICG technology in combination with ICG offers many advantages.

  • 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 many 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