Applications of fusion-fluorescence imaging using indocyanine green in laparoscopic hepatectomy
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Indocyanine green (ICG)-fluorescence imaging has been developed for real-time identification of hepatic tumors and segmental boundaries during hepatectomy. Fusion ICG-fluorescence imaging (real-time visualization of pseudocolor-fluorescence signals on white-light color images) may serve as a reliable navigation tool especially in laparoscopic hepatectomy, in which gross inspection and palpation are limited.
The study population consisted of 41 patients undergoing laparoscopic hepatectomy. Hepatic tumors were identified by fluorescence imaging following the preoperative intravenous administration of ICG (0.5 mg/kg body weight). To visualize hepatic perfusion and segmental boundaries, ICG (1.25 mg) was injected intravenously during surgery, following closure of the proximal portal pedicle. A laparoscopic imaging system, which enabled superimposition of the pseudocolor-fluorescence images on white color images, was used for the fusion ICG-fluorescence imaging.
Among the 53 malignant tumors resected, fusion ICG-fluorescence imaging revealed 45 nodules (85%), including three nodules of colorectal liver metastasis unidentifiable by white-light color images or intraoperative ultrasonography. It also delineated the segmental boundaries on the hepatic raw surfaces as well as on the phrenic/visceral surfaces in all 12 patients evaluated using this technique.
Fusion imaging enhances the feasibility of intraoperative ICG-fluorescence imaging in the identification of hepatic tumors and segmental boundaries. It may therefore help surgeons in the safe and accurate completion of laparoscopic hepatectomies.
KeywordsLaparoscopic hepatectomy Indocyanine green Fluorescence imaging Hepatic segmentectomy Colorectal liver metastasis
This work was supported by Grants from the Mochida Memorial Foundation for Medical, Foundation for Promotion of Cancer Research in Japan and Pharmaceutical Research and the Japan Agency for Medical Research and Development.
Compliance with ethical standards
Drs. Takeaki Ishizawa, Yosuke Inoue, Yoshihiro Mise, Yu Takahashi, and Akio Saiura have no conflicts of interest or financial ties to disclose.
Video, Supplemental Digital Content 1. Laparoscopic hepatectomy of S4sup extended to S3 and S4inf based on the ICG-fluorescence images. Supplementary material 1 (WMV 10902 kb)
Video, Supplemental Digital Content 2. ICG-fluorescence imaging identifies small colorectal metastases, located in S3 and S6, after preoperative chemotherapy. Supplementary material 2 (WMV 10289 kb)
Video, Supplemental Digital Content 3. Visualization of the segmental boundaries by fluorescence imaging after the intraoperative intravenous injection of ICG; hepatic resection of S5 was extended to include S6. Supplementary material 3 (WMV 10640 kb)
Video, Supplemental Digital Content 4. Visualization of the segmental boundaries by fluorescence imaging after the intraoperative intravenous injection of ICG; a limited resection of S3 with small extension to S2 was performed. Supplementary material 4 (WMV 10425 kb)
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