Real-Time Blood Flow Assessment Using ICG Fluorescence Imaging During Hepatobiliary and Pancreatic Surgery with Consideration of Vascular Reconstruction.

Background/objectives: Indocyanine green (ICG) fluorescence imaging is widely utilized for visualizing hepatic tumors, hepatic segmentation, and biliary anatomy, improving the safety and curability of cancer surgery. However, its application for perfusion assessment in hepatobiliary and pancreatic (HBP) surgery has been less explored.

Methods: This study evaluated outcomes of patients undergoing HBP surgery with vascular reconstruction from April 2022 to August 2024.

[Devising a Surgical Approach Using the Intestinal Derotation Procedure for Locally Advanced Pancreatic Cancer].

A 77-year-old man was diagnosed pancreatic head cancer(cT4cN0cM0, cStage Ⅲ)with a contrasting-enhanced CT scan showing soft-tissue shadow in contact with the SMA less than 180 degrees and extensive invasion of the SMV. After neoadjuvant chemotherapy(GnP was selected due to the possibility of unresectability), subtotal stomach-preserving pancreaticoduodenectomy( SSPPD)with resection and reconstruction portal vein was performed. Intestinal derotation procedure in combination with surgery, and there was no evidence of SMA invasion, and J2A, which was also suspected to be invaded on preoperative imaging, could be preserved.