Page 60 - Fluorescence-guided cancer surgery

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Chapter 4
ABSTRACT
Background: Uveal melanoma is the most common primary intraocular tumor in adults and up to 50% of patients will develop liver metastases. Complete surgical resection of these metastases can improve 5-year survival, but only a few patients are eligible for radical surgical treatment. The aim of this study was to introduce a near-infrared (NIR) uorescence laparoscope during minimally invasive surgery for intraoperative identi cation of uveal melanoma hepatic metastases and to use it to provide guidance during resection.
Methods: Three patients diagnosed with one solitary liver metastasis from uveal melanoma are presented. Patients received 10 mg indocyanine green (ICG) intravenously 24 h before surgery. A NIR uorescence laparoscope was used to detect malignant liver lesions.
Results: In all 3 patients, laparoscopic NIR uorescence imaging using ICG successfully identi ed uveal melanoma metastases. In 2 patients, multiple additional lesions were identi ed by inspection and NIR uorescence imaging, which were not identi ed by preoperative conventional imaging. In one patient, one additional lesion, not identi ed by computed tomography, magnetic resonance imaging, laparoscopic ultrasonography and inspection, was observed with NIR uorescence imaging only. Importantly, NIR uorescence imaging provided guidance during resection of these metastases.
Conclusions: We describe the successful use of laparoscopic identi cation and resection of uveal melanoma liver metastases using NIR uorescence imaging and ICG. This procedure is minimally invasive, and should be used as complementary to conventional techniques for the detection and resection of liver metastases.