Indocyanine Green Perfusion Imaging-Guided Laparoscopic Pancreaticoduodenectomy: Potential Application in Retroperitoneal Margin Dissection
- 44 Downloads
During laparoscopic pancreaticoduodenectomy (LPD), dissecting uncinate process from the superior mesenteric artery (SMA) will determine one of the important surgical margins (retroperitoneal margin) for predicting oncological outcomes and the quality of LPD. However, clear identification of the division line for retroperitoneal margin is not easy as the uncinate process of the pancreas is anatomically very close to SMA and intermingled with the nerve plexus and soft tissues around SMA. In this study, we present data regarding the potential usefulness of indocyanine green (ICG)-enhanced approach in obtaining retroperitoneal margin during LPD.
From January to September 2017, medical records of patients who underwent LPD for periampullary pathological conditions were retrospectively reviewed. ICG (5 mg/2 cm3) was prepared and intravenously injected when dissecting uncinate process of the pancreas. Perioperative outcomes, including gender, age, diagnosis, body mass index, operation time, estimated blood loss, transfusion, presence of postoperative pancreatic fistulas (POPFs), and length of hospital stay, were evaluated.
During the study period, a total of 37 patients underwent LPD for periampullary pathological lesions. Among them, ICG-enhanced dissection of uncinate process of the pancreas was applied in 10 patients (27%). All patients were able to obtain margin-negative resection. There were no significant differences between the perioperative outcomes of patients who did and did not undergo ICG-enhanced approach.
ICG perfusion-based laparoscopic dissection of retroperitoneal margin is feasible and safe in LPD. This intraoperative visual difference can provide the surgeon with very helpful real-time visual information. Further study is mandatory.
KeywordsLaparoscopic pancreaticoduodenectomy Retroperitoneal margin Indocyanine green ICG
Seoung Yoon Rho: Study designing, data analysis, interpretation, writing draft, revising final draft.
Ji Su Kim: Data interpretation, pathologic data handling.
Chang Moo Kang: Study designing, revising final draft, final approval of the version.
Jae Wook Jung, Ho Kyoung Hwang, Dong Sub Yoon, and Woo Jung Lee: data interpretation, revising initial draft.
- 5.Aoki T, Yasuda D, Shimizu Y, Odaira M, Niiya T, Kusano T, Mitamura K, Hayashi K, Murai N, Koizumi T, Kato H, Enami Y, Miwa M, Kusano M. Image-guided liver mapping using fluorescence navigation system with indocyanine green for anatomical hepatic resection. World J Surg 2008;32(8):1763–1767.CrossRefPubMedGoogle Scholar
- 6.Qi B, Crawford AJ, Wojtynek NE, Holmes MB, Souchek JJ, Almeida-Porada G, Ly QP, Cohen SM, Hollingsworth MA, Mohs AM. Indocyanine green loaded hyaluronan-derived nanoparticles for fluorescence-enhanced surgical imaging of pancreatic cancer. Nanomedicine: Nanotechnology, Biology and Medicine 2018;14(3):769–780.CrossRefGoogle Scholar
- 7.Hutteman M, van der Vorst JR, Mieog JSD, Bonsing BA, Hartgrink HH, Kuppen PJK, Löwik CWGM, Frangioni JV, van de Velde CJH, Vahrmeijer AL. Near-Infrared Fluorescence Imaging in Patients Undergoing Pancreaticoduodenectomy. European Surgical Research 2011;47(2):90–97.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Kim SH, Rho SY, Kang CM. Indocyanine Green-Fluorescent pancreatic perfusion-guided resection of distal pancreas in solid pseudopapillary neoplasm: usefulness and feasibility during pancreaticobiliary surgery. J Minim Invasive Surg 2018;acceptedGoogle Scholar
- 11.Kang CM. Robotic single-site plus ONE-port distal pancreatectomy. Annals of Pancreatic Cancer 2018;1(2).Google Scholar