Application of indocyanine green fluorescence imaging in laparoscopic liver surgery

Abstract

Objective \nTo study the clinical use of indocyanine green (ICG) fluorescence imaging in laparoscopic liver surgery. \n \n \nMethods \nThe clinical and pathological data of 68 patients who underwent la-paroscopic hepatectomy using the ICG fluorescence imaging technique during the study period from September 2016 to October 2018 in Zhongnan Hospital, Wuhan University were retrospectively analyzed. Analysis was carried out on the surgical methods, fluorescence navigation methods, ICG injection time and dose, tumor characteristics, and pathological studies of the resected specimens. \n \n \nResults \nOf 68 patients, 3 patients were converted to open surgery, and the remaining 65 patients completed the ICG fluorescence laparoscopic hepatectomy. Thirty-two of these 65 patients underwent ICG fluorescent guided laparoscopic anatomical resection of lower hepatic segment / hepatic hemilivers (positive staining in 17 patients, negative staining in 15 patients), with 19 patients successfully staining with ICG(19 / 32, 59.4%). Postoperative histopathology showed primary hepatic solid tumors (n=31), secondary liver tumors (n=12), hepatic cysts (n=4), hepatic hemangiomas (n=5), hepatolithiasis (n=12) and hepatic focal nodular hyperplasia (n=1). These lesions were combined with hepatitis B liver fibrosis in 29 patients. \n \n \nConclusions \nICG fluorescence imaging positively impacted on laparoscopic liver surgery. Proper preoperative ICG injection was helpful for the identification, localization and intraoperative surgical guidance of tumors, especially for patients with deep-seated and central tumors. As a consequence, oncological and surgical safety of laparoscopic liver surgery was improved. Targeted visualization of liver segments and surgical navigation using intraoperative ICG injections facilitated accurate and precise resection of anatomical liver segments or hemi-hepatectomies. The use of intraoperative ICG fluorescence technology for hepatic hemangioma, hepatic cyst, intrahepatic bile duct stones and other benign liver lesions, helped to improve safety of surgery. \n \n \nKey words: \nLiver neoplasm;\xa0Laparoscopes;\xa0Indocyanine green;\xa0Fluorescence imaging;\xa0Hepatectomy