Intraoperative bile duct visualization using near-infrared hyperspectral video imaging.

BACKGROUND: Current methodologies for imaging the biliary system during cholecystectomy are cumbersome and do not eliminate the risk of bile duct injury. We describe an approach to intraoperative biliary imaging that will enable surgeons to see through the hepatoduodenal ligament and visualize the anteriorly placed biliary system.
METHODS: A laparoscopic-capable, near-infrared, hyperspectral imaging system was built. Reflected light passes through a liquid crystal filter that is continuously tunable in the near-infrared spectrum (650-1,100 nm). Spectroscopic image data are collected from laparoscopic surgery images onto array detectors formatted into a 3-dimensional hyperspectral data cube having spatially resolved images in the x-y plane and wavelength data in the z plane. Deconvoluting and color-coding the spatial and spectral information provides an image representative of inherent chemical properties to the imaged tissue.
RESULTS: Images of porcine biliary structures were obtained. The common duct-reflected spectra displayed a characteristic lipid shoulder at 930 nm and a strong water peak at 970 nm. Venous structures had absorption peaks at 760 nm (deoxyhemoglobin), 800 nm (oxyhemoglobin), and 970 nm (water). Arterial vessels had absorption peaks at 800 nm and 970 nm that would be expected for oxyhemoglobin and water.
CONCLUSIONS: We have designed and constructed a device to significantly enhance intraoperative biliary imaging. This system should enable surgeons to see through the hepatoduodenal ligament and image the anteriorly placed biliary system without the need for dissection of the cystic duct, as is needed with intraoperative cholangiography. Because the biliary system can be seen before any dissection is performed, this dimensional imaging technology has the potential for eradicating bile duct injury.