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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 – it's up to you

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
  • 3D image quality improved over the predecessor
  • 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
  • Operation via touchscreen 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

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