Determination of the surgical margin in laparoscopic liver resections using infrared indocyanine green fluorescence

Aoki, Takeshi; Murakami, Masahiko; Koizumi, Toru; Matsuda, Kazuhiro; Fujimori, A.; Kusano, Tomokazu; Enami, Yuta; Goto, Satoru; Watanabe, Makoto; Otsuka, Koji

doi:10.1007/s00423-018-1685-y

Cited by 63 publications

(62 citation statements)

References 44 publications

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“…Conversely, in laparoscopic hepatectomy, this requires advanced skills. The lack of tactile perception of laparoscopic forceps and the complexity of intraoperative ultrasound examination makes it challenging to localize the tumor and confirm the demarcation line, limiting the application of this technology [5].…”

Section: Introductionmentioning

confidence: 99%

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Liang

Qian

et al. 2020

Surg Today

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Purpose To explore the role of indocyanine green (ICG) fluorescence navigation in laparoscopic hepatectomy and investigate if the timing of its administration influences the intraoperative observation. Methods The subjects of this retrospective study were 120 patients who underwent laparoscopic hepatectomy; divided into an ICG-FN group (n = 57) and a non-ICG-FN group (n = 63). We analyzed the baseline data and operative data. Results There were no remarkable differences in baseline data such as demographic characteristics, lesion-related characteristics, and liver function parameters between the groups. Operative time and intraoperative blood loss were significantly lower in the ICG-FN group. The rate of R0 resection of malignant tumors was comparable in the ICG-FN and non-ICG-FN groups, but the wide surgical margin rate was significantly higher in the ICG-FN group. The administration of ICG 0–3 or 4–7 days preoperatively did not affect the intraoperative fluorescence imaging. Operative time, intraoperative blood loss, and a wide surgical margin correlated with ICG fluorescence navigation. ICG fluorescence navigation helped to minimize intraoperative blood loss and achieve a wide surgical margin. Conclusion ICG fluorescence navigation is safe and efficient in laparoscopic hepatectomy. It helps to achieve a wide surgical margin, which could result in a better prognosis. The administration of ICG 0–3 days preoperatively is acceptable.

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Section: Introductionmentioning

confidence: 99%

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Liang

Qian

et al. 2020

Surg Today

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“…Its main advantage is that it determines the hepatic plane more accurately, while also having significant implications for guaranteeing the negative surgical margin. 11 The uptake of ICG by hepatocytes is achieved through the OATP1B3 and NTCP transporters, whereas excretion is carried out by the multidrug resistance–associated protein 2 (MRP2) transporter system on the hepatocyte membrane of the bile canaliculi. When tumors, heteroplasia, and cirrhotic nodules develop in the liver, its mechanism for ICG uptake remains normal; however, its mechanism for ICG excretion is impaired, thereby enabling ICG to remain in solid hepatic space-occupying lesions during surgery.…”

Section: Discussionmentioning

confidence: 99%

Precision Liver Resection: Three-Dimensional Reconstruction Combined with Fluorescence Laparoscopic Imaging

Lin

Wang

et al. 2020

Surg Innov

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Liver surgery has entered the era of precision surgery. Therefore, how to optimize the resection of lesions and reduce the unnecessary time of liver ischemia and hypoxia have become the focus. A total of 11 patients who underwent fluorescence laparoscopic liver mass resection and preoperative three-dimensional (3D) reconstruction between August 2018 and July 2020 were evaluated. Liver cirrhosis occurred in 3 patients. The mean intraoperative blood loss was 166.8 ± 105.7 mL. The average length of the operation time was 152.0 ± 45.3 minutes. The average intraoperative hilar occlusion time was 9.3 minutes (except for hilar cholangiocarcinoma). The liver function of all patients, except patients with hilar bile duct carcinoma, returned to the preoperative level at 72 hours, and no serious complications occurred. 3D reconstruction combined with fluorescence laparoscopic imaging is safe and effective for precision liver resection.

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“…The PINPOINT system allows for a simultaneous overlay view of the normal white-light mode and NIR mode with the same focal range through a single endoscope, allowing surgeons to perform operations in real time without frequent switching of the screens. This technique has already been applied to laparoscopic cholecystectomy to visualize the biliary anatomy, colorectal surgery to assess the blood supply in the anastomosis, and laparoscopic liver resection to help surgeons identify tumor margin [29,30,31,32]. We reported the first application of this system to metastasectomy in an HB patient [33].…”

Section: Modalitiesmentioning

confidence: 99%

Fluorescence-Guided Surgery for Hepatoblastoma with Indocyanine Green

Yamada

Ohno

Fujino

et al. 2019

Cancers

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Fluorescence-guided surgery with indocyanine green (ICG) for malignant hepatic tumors has been gaining more attention with technical advancements. Since hepatoblastomas (HBs) possess similar features to hepatocellular carcinoma, fluorescence-guided surgery can be used for HBs, as aggressive surgical resection, even for distant metastases of HBs, often contributes positively to R0 (complete) resection and subsequent patient survival. Despite a few caveats, fluorescence-guided surgery allows for the more sensitive identification of lesions that may go undetected by conventional imaging or be invisible macroscopically. This leads to precise resection of distant metastatic tumors as well as primary liver tumors.

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Determination of the surgical margin in laparoscopic liver resections using infrared indocyanine green fluorescence

Abstract: This technique showed the potential to improve the intraoperative identification and demarcation of tumors. Its use could potentially reduce the number of positive resection margins.

Cited by 63 publications

References 44 publications

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Precision Liver Resection: Three-Dimensional Reconstruction Combined with Fluorescence Laparoscopic Imaging

Fluorescence-Guided Surgery for Hepatoblastoma with Indocyanine Green

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