Anatomical Laparoscopic Hepatectomy for Hepatocellular Carcinoma Using Indocyanine Green Fluorescence Imaging

Shimada, Masahiko; Ueno, S.; Iino, Satoshi; Hiwatashi, Kiyokazu; Minami, Koji; Kawasaki, Yota; Kurahara, Hiroshi; Mataki, Yukou; Maemura, Kousei; Uenosono, Yoshikazu; Shinchi, Hiroyuki; Natsugoe, Shoji

doi:10.1089/lap.2014.0243

Cited by 40 publications

(20 citation statements)

References 21 publications

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“…However, only 1 small study and 3 case reports describe this technique during minimally-invasive liver surgery [9, 28, 29, 30]. Our group previously reported feasibility of UMLM detection in 3 patients during laparoscopic resection [9].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic detection and resection of occult liver tumors of multiple cancer types using real-time near-infrared fluorescence guidance

et al. 2016

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Background Tumor recurrence after radical resection of hepatic tumors is not uncommon, suggesting that malignant lesions are missed during surgery. Intraoperative navigation using fluorescence guidance is an innovative technique enabling real-time identification of (sub)capsular liver tumors. The objective of the current study was to compare fluorescence imaging (FI) and conventional imaging modalities for laparoscopic detection of both primary and metastatic tumors in the liver. Methods Patients undergoing laparoscopic resection of a malignant hepatic tumor were eligible for inclusion. Patients received standard-of-care, including preoperative CT and/or MRI. In addition, 10 mg indocyanine green was intravenously administered one day prior to surgery. After introduction of the laparoscope, inspection, FI, and laparoscopic ultrasonography (LUS) were performed. Histopathological examination of resected suspect tissue was considered the gold standard. Results Twenty-two patients suspected to have hepatocellular carcinoma (n=4), cholangiocarcinoma (n=2) or liver metastases from colorectal carcinoma (n=12), uveal melanoma (n=2) and breast cancer (n=2) were included. Two patients were excluded because their surgery was unexpectedly postponed several days. Twenty-six malignancies were resected in the remaining 20 patients. Sensitivity for various modalities was 80% (CT), 84% (MRI), 62% (inspection), 86% (LUS) and 92% (FI), respectively. Three metastases (12%) were identified solely by FI. All 26 malignancies could be detected by combining LUS and FI (100% sensitivity). Conclusion This study demonstrates added value of FI during laparoscopic resections of several hepatic tumors. Although larger series will be needed to confirm long-term patient outcome, the technology already aids the surgeon by providing real-time fluorescence guidance.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic detection and resection of occult liver tumors of multiple cancer types using real-time near-infrared fluorescence guidance

et al. 2016

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“…Anatomical hepatectomy is one of the most ideal surgical methods for precise hepatectomy with the ability of accurately defining the range of liver sections. The main approach to mark the scope of resection in the anatomical right hemihepatectomy involves blocking the right branch of the portal vein and the right hepatic artery, marking the ischemic line on the liver surface, and cutting along the ischemic line [19][20][21]. Then, the right branch of the puncture portal vein was injected with methylene blue, the right hemi liver was stained, and the resection margin was determined based on the staining results.…”

Section: Discussionmentioning

confidence: 99%

Precise right hemihepatectomy for the treatment of hepatocellular carcinoma guided by fusion ICG fluorescence imaging

Yao¹,

Zhang²,

Ma³

et al. 2020

J. Cancer

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To evaluate the clinical significance of fusion indocyanine green (ICG) fluorescence imaging in precise right hemihepatectomy for the treatment of hepatocellular carcinoma (HCC). 47 patients with HCC who underwent right hemihepatectomy were retrospectively analyzed. 18 of them guided by fusion ICG fluorescence imaging (FIGFI) while 29 patients underwent conventional right hepatectomy without guidance. Compared to the patients with conventional treatment, the intraoperative blood loss of the patients with guided surgery was significantly less, and no transfusion and hepatic occlusion were performed during the operation. Liver function recovery faster in guided group. The incidence of postoperative complications is also lower, and the recurrence rate in one year is significantly reduced. ICG fluorescence range of 18 patients in liver surface was consistent with the ischemic line, and their postoperative liver cross-sections were clearly demarcation. There were no significant differences in the mean operation time, blood loss, postoperative hospital stays, cases of blood transfusion, complication rate, or postoperative peak volume of ALT and TB between positive or negative staining groups. Pathology results of all patients demonstrated HCC and negative margins, and microvascular invasion occurred in 8 cases. The average follow-up time of 18 patients was 16.7 months, and recurrence was found in 5 cases after surgery. FIGFI could guide the anatomical right hepatectomy with real-time increased radical rate, accuracy and safety for the treatment of HCC, and therefore showed a promising prospect.

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“…This point is all the more true for livers altered by chemotherapy (blue liver syndrome) or by surgical procedures (repeat hepatectomies) for which the use of blue or ischemic staining might be less reliable and less effective. In 2014, Sakoda et al again showed the feasibility and the relevance of this staining method for laparoscopic hepatectomy, with a ultrasound‐guided injection of 1 mL of ICG (5 mg/mL) in a portal branch.…”

Section: Discussionmentioning

confidence: 99%

HEPATOFLUO: A prospective monocentric study assessing the benefits of indocyanine green (ICG) fluorescence for hepatic surgery

Peyrat

Blanc

Guillermet³

et al. 2018

Journal of Surgical Oncology

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Anatomical Laparoscopic Hepatectomy for Hepatocellular Carcinoma Using Indocyanine Green Fluorescence Imaging

Abstract: Pure laparoscopic segmentectomy for HCC with a conventional puncture technique by ICG injection under laparoscopic US is considered to be a useful procedure featuring both low invasiveness and curative success.

Cited by 40 publications

References 21 publications

Laparoscopic detection and resection of occult liver tumors of multiple cancer types using real-time near-infrared fluorescence guidance

Laparoscopic detection and resection of occult liver tumors of multiple cancer types using real-time near-infrared fluorescence guidance

Precise right hemihepatectomy for the treatment of hepatocellular carcinoma guided by fusion ICG fluorescence imaging

HEPATOFLUO: A prospective monocentric study assessing the benefits of indocyanine green (ICG) fluorescence for hepatic surgery

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