1. LLNL-PRES-647318This work was performed under the auspices of theU.S. Department of Energy by Lawrence LivermoreNational Laboratory under contract DE-AC52-07NA27344.Lawrence Livermore National Security, LLCStavros Demos

2. Detect locations of disease Verify complete removalafter surgery Detect and preserveanatomical features ofimportanceLawrence Livermore National LaboratoryLLNL-PRES-6473182Intraoperative imaging using targeting fluorescing contrastagents has been shown to be an effective navigation tool 3. Lawrence Livermore National LaboratoryLLNL-PRES-6473183and is adaptable to any conventional endoscope system 4. Lawrence Livermore National LaboratoryKey advantages of our system It is easy to handle (low weight, compact) Simultaneous image acquisition Optimal sensitivity It can be multiplexed to use multiple contrastagents It can be adapted to any endoscope typesystem for multi-purpose use in the OR It is relatively inexpensive to manufactureLLNL-PRES-6473184Hamamatsu system, Aoki et.Al., J Hepatobiliary Pancreat Sci., 2010Intuitive Surgical system, Robotic system, Spinoglio et. Al. Surg Endosc, Dec 2012 5. Lawrence Livermore National LaboratoryLLNL-PRES-6473185Competition: One camera acquires alternately color and spectral imagesOur approach: Separate image-coupled cameras acquire images in parallelOur approach provides orders of magnitude higher sensitivity 6. Enhancing the visualization of the biliarysystem during laparoscopic surgery 750,000 patients undergo laparoscopicLawrence Livermore National LaboratoryLLNL-PRES-6473186Biliary Systemcholecystectomy/year USA Common Bile Duct (CBD) injury occurs in 1/200operations (4000/yr) Multiple reconstructive operations and procedures,increased mortality, and lifelong disability Liability/Medical costs: $250k-$1M per occurrence Most significant injury occurs when surgeonmisidentifies CBD as cystic duct and cuts thisstructureThe concepts are directly applicable to other clinicalneeds such as cancer detection and the vascular systemvisualization 7. Cannulation of the cystic duct and associatedcomplications (which can include: Infection, bleeding,pancreas inflammation, damage to the common bile duct) 10-20 minutes of OR time Exposure to radiation Live image is not available during the dissection phase Anatomy is not directly overlaid onto the surgical field Operator dependent interpretation Cost/benefit questionable as a routine procedureLawrence Livermore National LaboratoryLLNL-PRES-6473187 97% of errors due to visual perceptual illusion Faults in technical skill only 3% of injuries 8. ICG is administered intravenously before surgery ICG is nearly exclusively eliminated by the liverinto the bile Intraoperative fluorescent cholangiographyusing ICG was first demonstrated in 2009 byIshizawa et. Al., J Am Coll Surg. 208 (see left,open surgery)Lawrence Livermore National LaboratoryLLNL-PRES-647318 A large number of publications have beenproduced in the last 4 years on this topic,highlighting the clinical importance of thismethod8 9. ICG emission image RGB conventional imageLawrence Livermore National LaboratoryLLNL-PRES-6473189Imaging the gallbladder and bile ducts using ICGEx vivo images using animal model 10. ICG image of tube Conventional image ICG emission imageLawrence Livermore National LaboratoryLLNL-PRES-647318103 mm plastic tubecontaining ICG solution5-mm thick bovinemuscle tissue coveringthe tubeICG fluorescence imagethrough the 5-mm tissue 11. Lawrence Livermore National LaboratoryLLNL-PRES-64731811Conventional image ICG fluorescence image Composite imageBile duct covered by twolayers of intestinal wallICG image visualizesubsurface bile ductImage superposition canassist real time navigation 12. Lawrence Livermore National LaboratoryLLNL-PRES-64731812 13. Our system design offers optimized sensitivity andfunctionality for endoscopic/laparoscopic NIR fluorescentsubsurface imaging This design could provide low-cost and real-time surgicalnavigation capability for minimally invasive surgery Common bile duct Blood vessels Cancer (Sentinel lymph node biopsy) Any application with a fluorescent contrast agentLawrence Livermore National LaboratoryLLNL-PRES-64731813 14. Lawrence Livermore National LaboratoryLLNL-PRES-64731814Genaro Mempinmempin1@llnl.gov