Volume 149, Issue 6, Pages 1334-1336 (November 2015) Intraoperative Visualization of Pancreatic Juice Leaking From the Pancreatic Stump in a Swine Model  Kazuhiro Mori, Takeaki Ishizawa, Suguru Yamashita, Mako Kamiya, Yasuteru Urano, Norihiro Kokudo  Gastroenterology  Volume 149, Issue 6, Pages 1334-1336 (November 2015) DOI: 10.1053/j.gastro.2015.07.068 Copyright © 2015 AGA Institute Terms and Conditions

Figure 1 Fluorescence imaging of pancreatic juice leaking from the pancreatic stump using a chymotrypsin probe. A, The chymotrypsin probe is sprayed on the pancreatic stump after closure with a surgical stapler (left). Fluorescence imaging using a FluorVivo imaging system enables the detection of 2 pancreatic leakage points on the stapler line 3 minutes after the administration of the chymotrypsin probe (right). B, Leakage of pancreatic juice (arrow and arrowheads) is detectable by naked-eye examination under blue light illumination through light-blocking glasses (515-nm long-pass) after administration of the chymotrypsin probe (left). One of the 3 leakage points (arrow) was closed by suturing using fluorescence imaging (middle). Fluorescence imaging after irrigation of the pancreatic stump with 50 mL of saline and the second administration of the chymotrypsin probe indicates partial control of the pancreatic leak (right, see Supplementary Video). C, The fluorescence intensity of the leakage points (solid lines) increased with time and was 2.0- to 5.5-fold higher than preadministration values at 3 minutes, whereas the fluorescence intensity of the staple line without visible fluorescence signals (12 points were selected) remains flat (dotted lines). Red lines indicate closure of the pancreatic remnant with a white cartridge and blue lines indicate the use of green cartridges. D, Microscopic examination of the pancreatic stump. The left image indicates closure of pancreatic duct branches (white arrow) and the insufficiently closed ductal stumps (yellow arrows) close to the pinholes that may have been created after removal of staples (yellow arrowheads). The right image shows the stump of the main pancreatic duct with small openings (white arrowheads) in its lumen. Bars indicate 300 μm. Gastroenterology 2015 149, 1334-1336DOI: (10.1053/j.gastro.2015.07.068) Copyright © 2015 AGA Institute Terms and Conditions