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The Application of Indocyanine Green Fluorescence Imaging During Robotic Liver Resection: A Case-Matched Study

Abstract

Background

The ICG fluorescence properties are progressively gaining momentum in the HPB surgery. However, the exact impact of ICG application on surgical outcomes is yet to be established.

Methods

Twenty-five patients who underwent ICG fluorescence-guided robotic liver resection were case-matched in a 1:1 ratio to a cohort who underwent standard robotic liver resection.

Results

In the ICG group, six additional lesions not diagnosed by preoperative workup and intraoperative ultrasound were identified and resected. Four of the lesions were proved to be malignant. Despite the similar operative time (288 vs. 272 min, p = 0.778), the risk of postoperative bile leakage (0% vs. 12%, p = 0.023), R1 resection (0% vs. 16%, p = 0.019) and readmission (p = 0.023) was reduced in the ICG group compared with the no-ICG group.

Conclusions

The ICG fluorescence is a real-time navigation tool which enables surgeons to enhance visualization of anatomical structures and overcome the disadvantages of minimally invasive liver resection. The procedure is not time-consuming, and its applications can reduce the postoperative complication rate in robotic liver surgery.

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Author information

MVM contributed to study conception and design, acquisition, interpretation and analysis of data; drafting and critically revising the article for important intellectual content; and final approval of the version to be published. SDS was involved in interpretation and analysis of data; drafting and critically revising the article for important intellectual content; editing and revising the English for the final version to be published; and final approval of the version to be published. MP and MGR contributed to interpretation and analysis of data; drafting and critically revising the article for important intellectual content; and final approval of the version to be published. MGF was involved in study conception and design; interpretation and analysis of data; drafting and critically revising the article for important intellectual content; and final approval of the version to be published.

Correspondence to Marco Vito Marino.

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Conflict of interest

Marco Vito Marino, Salomone Di Saverio, Mauro Podda and Manuel Gomez Fleitas have no conflict of interest to disclose. Marcos Gomez Ruiz is Proctor and Advisor of Intuitive Surgical Inc., Medtronic, and Johnson & Johnson.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was conducted after the approval of the Institutional Ethics Review Board of Hospital Universitario Marquès de Valdecilla.

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

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Marino, M.V., Di Saverio, S., Podda, M. et al. The Application of Indocyanine Green Fluorescence Imaging During Robotic Liver Resection: A Case-Matched Study. World J Surg 43, 2595–2606 (2019). https://doi.org/10.1007/s00268-019-05055-2

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