Perioperative and Disease-Free Survival Outcomes after Hepatectomy for Centrally Located Hepatocellular Carcinoma Guided by Augmented Reality and Indocyanine Green Fluorescence Imaging: A Single-Center Experience

Abstract

BACKGROUND: Laparoscopic hepatectomy for centrally located hepatocellular carcinoma is challenging to perform. Augmented reality navigation (ARN) and fluorescence imaging are currently safe and reproducible techniques for hepatectomy, but the efficacy results for centrally located hepatocellular carcinoma have not been reported. This study aimed to evaluate the efficacy of an ARN system combined with fluorescence imaging (ARN-FI) in laparoscopic hepatectomy for centrally located hepatocellular carcinoma. STUDY DESIGN: This was a post hoc analysis of an original nonrandomized clinical trial that was designed to evaluate the feasibility and efficacy of ARN-FI for laparoscopic liver resection. A total of 76 patients were consecutively enrolled from June 2018 to June 2021, of which 42 underwent laparoscopic hepatectomy using ARN-FI (ARN-FI group), and the other 34 who did not use ARN-FI guidance (non–ARN-FI group). Perioperative outcomes and disease-free survival were compared between the 2 groups. RESULTS: Compared with the non–ARN-FI group, the ARN-FI group had less intraoperative blood loss (median 275 vs 300 mL, p = 0.013), lower intraoperative transfusion rate (14.3% vs 64.7%, p < 0.01), shorter postoperative hospital stay (median 8 vs 9 days, p = 0.005), and lower postoperative complication rate (35.7% vs 61.8%, p = 0.024). There was no death in the perioperative period and follow-up period. There was no significant difference in overall disease-free survival between the 2 groups (p = 0.16). CONCLUSIONs: The ARN system and fluorescence imaging may be of value in improving the success rate of surgery, reducing postoperative complications, accelerating postoperative recovery, and shortening postoperative hospital stay.

Current Trends in Surgical Management of Hepatocellular Carcinoma

“…The group found that the patients undergoing surgery with the combination of ARN and fluorescent imaging had significantly reduced intraoperative blood loss and transfusion rates, shorter postoperative length of stay, and lower perioperative complication rates when compared to patients undergoing routine laparoscopic hepatectomy. They also found that the combination of methods significantly reduced the rate of conversion to laparotomy (35.7% vs. 61.8%, p = 0.024) [91].…”

“…This technique uses CT images to create a 3D reconstruction of the anatomy and can help to determine a tumor's resectability, as well as a surgical plan [90]. Recently, studies have explored the possibility of using 3D models in real time during surgery, an approach named augmented reality navigation (ARN) [91,92].…”

“…By facilitating identification of important structures, these technologies have the potential of overcoming limitations of resecting tumors located in challenging areas [91]. Zhu et al conducted a study to assess the efficacy of the combination of ARN and ICGfluorescent imaging for laparoscopic resection of centrally located HCCs.…”

“…The group found that the patients undergoing surgery with the combination of ARN and fluorescent imaging had significantly reduced intraoperative blood loss and transfusion rates, shorter postoperative length of stay, and lower perioperative complication rates images to create a 3D reconstruction of the anatomy and can help to determine a tumor's resectability, as well as a surgical plan [90]. Recently, studies have explored the possibility of using 3D models in real time during surgery, an approach named augmented reality navigation (ARN) [91,92]. ARN systems facilitate identification of the anatomy and spatial distribution of the liver, vascular, and biliary structures due to the depth perception provided by 3D visualization, as well as the assignment of colors for each type of structure [92].…”

Safety and effectiveness of indocyanine green fluorescence imaging-guided laparoscopic hepatectomy for hepatic tumor: a systematic review and meta-analysis

“…Among them, 1,919 studies were excluded due to duplication, and an additional 2,731 studies were removed after reviewing their titles and abstracts. The remaining 39 full-text articles were reviewed, followed by the removal of 28 articles for various reasons, resulting in the inclusion of 11 studies (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) in the meta-analysis (Figure 1). All 11 studies were retrospective cohort studies, with nine conducted in China and the remaining two in Japan.…”