Indocyanine Green Near-Infrared Fluorescence in Pure Laparoscopic Living Donor Hepatectomy: a Reliable Road Map for Intra-Hepatic Ducts ?

Abstract

Indocyanine green (ICG) near-infrared (NIR) fluorescence cholangiography (FC) has shown its usefulness to visualize the biliary ducts in open living donor hepatectomy (LDH) to check the intraoperative biliary anatomy. The fully laparoscopic LDH approach has been recently described. However, this procedure is very demanding for a possible misperception of right parenchymal transection line and the cut point of the lobar biliary ducts (BD). To explore the potential of ICG-NIR-FC method we report our experience in 11 fully laparoscopic left LDH using 5 different protocols. Protocol-A, consisted on intravenous (i.v.) ICG injection of 2.5 mg with immediate cut of the BD; -B, same dose and late cut; -C, 1 mg i.v. and late cut; -D, intra-cystic duct injection of 2.5 mg and immediate cut; -E, intra-cystic injection of 5 mg and immediate cut. Protocol-A showed fast fluorescence in the lobar artery and portal vein followed by the BD sheet; -B showed intraductal excretion with a high parenchymal signal; -C showed a very week signal; -D failed to visualize the ducts; -E showed a good signal without parenchymal fluorescence. ICG-NIR-FC is an additional method to visualize the lobar ducts in fully laparoscopy LDH, but still insufficient for the segmental ducts.

Robotic Versus Open Right Lobe Donor Hepatectomy for Adult Living Donor Liver Transplantation: A Propensity Score–Matched Analysis

“…The robotic Firefly system makes it possible to better understand the biliary anatomy, although the results are not always uniformly reproduced with the same quality. ( 19,23 ) However, with the combination of the Firefly and the probing, we were able to reproduce robotically our conventional open approach, identifying the site where the bile ducts could be cut without the need for intraoperative cholangiogram. No graft dysfunction as the result of a significantly longer warm ischemia time leading to severe cholestasis and/or need for retransplantation was recorded in RRLDH, as already shown.…”

Novel method of intraoperative liver tumour localisation with indocyanine green and near-infrared imaging

“…(27,22) The fluorescence and bile excretion of ICG has been developed as a tool for real-time hepatic tumour localisation and identification, and during parenchymal transection for anatomic resection of hepatic tumours. (28) Fusion ICG fluorescence imaging enables visualisation of pseudocolour-fluorescence signals on whitelight colour images and serves as a reliable localisation method, especially in laparoscopic surgery in which gross inspection and palpation may be limited. (29) It is particularly helpful in laparoscopic surgery and in cirrhotic livers due to the challenge of distinguishing dysplastic or regenerative nodules from tumours on IOUS.…”

Survey Results of the Expert Meeting on Laparoscopic Living Donor Hepatectomy and Literature Review

“…Some centers no longer use intraoperative cholangiography because preoperative magnetic resonance cholangiopancreatography has replaced it. Indocyanine green fluorescent imaging can be used to manage the bile duct during laparoscopic/robotic donor right hepatectomy [25], although experience with this technique is currently limited. Recent successful laparoscopic donor right hepatectomy in a donor with trifurcation of the bile duct has also been reported [20].…”