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

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Abstract

Purpose

Laparoscopic liver resection is increasingly used to treat patients with hepatic tumor. However, during laparoscopic resection, information obtained by palpation using laparoscopic forceps or from intraoperative ultrasonography is extremely limited, which may pose a risk for positive surgical margins. This study aimed to investigate the feasibility and clinical application of near-infrared (NIR) fluorescence imaging to guide laparoscopic liver resection of a liver tumor and secure the surgical margins.

Methods

A preliminary study in 25 patients was conducted. NIR imaging was used intraoperatively during laparoscopic liver resection. The liver tumors were preoperatively labeled by intravenously injecting the patients with indocyanine green dye (0.5 mg/kg), an NIR fluorescence agent. During the surgical procedure, the PINPOINT Endoscopic Fluorescence Imaging System was used to assess the surgical margin by using real-time endoscopic high-definition visible and NIR fluorescence imaging.

Results

All tumors were identified and resected laparoscopically by using the PINPOINT system, and all resections successfully secured the surgical margin. The pathological findings of all tumors indicated negative margins, defined as R0.

Conclusions

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.

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Acknowledgements

The authors thank Dr. Kosuke Yamada, Dr. Koji Nogaki, and Dr. Yoshihiko Tashiro (Showa University) for their assistance with acquisition of data; Dr. Yusuke Wada, Dr. Tomoki Hakozaki, Dr. Kodai Tomioka, and Dr. Hideki Shibata (Showa University); and Dr. Kris Siriratsivawong (Showa University) for the revision of the manuscript.

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Authors and Affiliations

  1. Department of Gastroenterological and General Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 1428666, Japan

    Takeshi Aoki, Masahiko Murakami, Tomotake Koizumi, Kazuhiro Matsuda, Akira Fujimori, Tomokazu Kusano, Yuta Enami, Satoru Goto, Makoto Watanabe & Koji Otsuka

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  1. Takeshi Aoki
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  2. Masahiko Murakami
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Contributions

T. A. and M. M. were responsible for the study conception and design; T. K., K. M., A. F., and T. K. for the acquisition of data; Y. E., S. G., M. W., and K. O. for the analysis and interpretation of data; T. A. for the drafting of the manuscript; and M. M. for the critical revision of the manuscript.

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Correspondence to Takeshi Aoki.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Aoki, T., Murakami, M., Koizumi, T. et al. Determination of the surgical margin in laparoscopic liver resections using infrared indocyanine green fluorescence. Langenbecks Arch Surg 403, 671–680 (2018). https://doi.org/10.1007/s00423-018-1685-y

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