A novel transendoscopically implantable miniature silicone-rubber marker emitting high-intensity near-infrared fluorescence for image-guided laparoscopic gastrointestinal surgery: HICARL bullet

BACKGROUND: A recent advancement in imaging technology for near-infrared fluorescence (NIRF) with high penetrance of biological tissues allows for precise and safe image-guided surgery. Here, we developed a prototype of a transendoscopically implantable miniature NIRF silicone-rubber marker, HICARL bullet, and experimentally confirmed its NIRF performance required for image-guided laparoscopic surgery of the alimentary tract. METHODS: The HICARL bullet with a diameter of 0.7 mm and a length of 3 mm was molded from NIRF silicone rubber we developed previously, emitting NIRF at a wavelength of 820-880 nm in response to excitation light at a wavelength of 740-800 nm. A specialized tool was fabricated for transendoscopically implanting the HICARL bullet into the submucosa of the alimentary tract through a forceps bore within a gastrointestinal videoscope. RESULTS: The HICARL bullet demonstrated 9.3 times higher NIRF brightness than an ethanol solution of indocyanine green (5 μg/mL), and was unambiguously identified by its NIRF with high intensity through a 15-mm-thick chicken muscle strip. The transendoscopically implanted HICARL bullet into the submucosa of an in vivo porcine stomach exhibited superior visibility from the serosa side when compared to a commercially available NIRF clip (ZEOCLIP FS, Zeon Medical) placed on the mucosa. CONCLUSIONS: The HICARL bullet could serve as a promising NIRF marker for reliably delineating the demarcation line during image-guided laparoscopic surgery for gastrointestinal cancer.