Intraoperative guidance using ICG fluorescence imaging system for safe and precise laparoscopic liver resection.

Abstract

BACKGROUND\nLaparoscopic liver resection (LLR) has been spread as minimally ivasive surgery for liver disease. Aadvances in surgical technique and devices enabled us to performe various procedures of LLR. Indocyanine green (ICG) fluorescence imaging has been suggested as useful tool to identifiy liver tumors, anatomical territory of liver parenchyma, and cholangiography in open liver surgery. Due to recent development, this technology can be applied in LLR. we describe safe and effective using of the ICG fluorescence imaging during LLR.\n\n\nMETHODS\nFrom September 2013 to August 2019, 34 patients were performed LLR using a total of 46 procedures by ICG fluorescence imaging system for purposes including identification of anatomic domain of the liver in 12 LLRs, detection of liver tumors in 30 nodules, or intraoperative cholangiography in 4 LLRs.\n\n\nRESULTS\nIn the detection of liver tumors, 25 nodules in 30 malignant to benign tumors were positively detected (83.3%). Although there has been no publication regarding information on ICG fluorescence imaging of low grade malignant or benign tumors, we found positive emission in focal nodular hyperplasia, an angiomyolipoma, and an intraductal papillary neoplasm of the bile duct. The identification of anatomic domain in the liver was successful in all 12 LLRs with negative and positive staining techniques. In the intraoperative cholangiography, all 4 tests were successfully performed. One of 4 patients were found to have bilialy leakage which was repaired intraoperatively.\n\n\nCONCLUSIONS\nThe ICG fluorescence imaging could be useful in safe and precise performance of LLR.