Abstract
Purpose
The clear demarcation line is ideal for real-time surgical navigation imaging during hepatectomy.
Methods
The study population was comprised of 22 patients with moderate liver cirrhosis scheduled to undergo an anatomical liver resection for the treatment of hepatocellular carcinoma. This study set out to assess the clinical value of the concomitant intra-operative use of contrast-enhanced intra-operative ultrasound using Sonazoid™, and a fluorescence navigation system (PDE) with ICG, as a novel tool for patients undergoing an anatomical liver resection.
Results
Following portal pedicle ligation for anatomical resection, 2 min after injection of ICG, the segments to be resected were detected as a negative-brightness area using PDE fluorescence. Sonazoid™ administration provides a parenchymal transectional line, as the margin of a loss of blood flow shows a hypo-enhanced image, and the resectional line of the parenchyma can be confirmed by CE-IOUS. Although the demarcation line of the liver surface after the portal pedicle ligation was apparent in 17 patients, the resection line using PDE was clearly detected in all 22 patients (p < 0.018).
Conclusions
The combined use of these methods is therefore considered to be useful and safe for surgeons, as an additional tool for performing a liver resection.
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References
Tajima Y, Yamazaki K, Masuda Y, Kato M, Yasuda D, Aoki T, Kato T, Murakami M, Miwa M, Kusano M (2009) Sentinel node mapping guided by indocyanine green fluorescence imaging in gastric cancer. Ann Surg 249:58–62
Troyan SL, Kianzad V, Gibbs-Strauss SL, Gioux S, Matsui A, Oketokoun R, Ngo L, Khamene A, Azar F, Frangioni JV (2009) The FLARE intraoperative near-infrared fluorescence imaging system: a first-in-human clinical trial in breast cancer sentinel lymph node mapping. Ann Surg Oncol 16:2943–2952
Tralhão JG, Hoti E, Oliveiros B, Abrantes AM, Botelho MF, Castro-Sousa F (2009) Intermittent pringle maneuver and hepatic function: perioperative monitoring by noninvasive ICG-clearance. World J Surg 33:2627–2634
Ishizawa T, Fukushima N, Shibahara J, Masuda K, Tamura S, Aoki T, Hasegawa K, Beck Y, Fukayama M, Kokudo N (2009) Real-time identification of liver cancers by using indocyanine green fluorescent imaging. Cancer 115:2491–2504
Hashimoto T, Miki K, Imamura H, Sano K, Satou S, Sugawara Y, Kokudo N, Makuuchi M (2008) Sinusoidal perfusion in the veno-occlusive region of living liver donors evaluated by indocyanine green and near-infrared spectroscopy. Liver Transplant 14:872–880
Uchiyama K, Ueno M, Ozawa S, Hayami S, Kawai M, Tani M, Mizumoto K, Haba M, Hatano Y, Yamaue H (2009) Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure. Langenbecks Arch Surg 394:243–247
Luo W, Numata K, Kondo M, Morimoto M, Sugimori K, Hirasawa K, Nozaki A, Zhou X, Tanaka K (2009) Sonazoid-enhanced ultrasonography for evaluation of the enhancement patterns of focal liver tumors in the late phase by intermittent imaging with a high mechanical index. J Ultrasound Med 28:439–448
Torzilli G, Palmisano A, Del Fabbro D, Marconi M, Donadon M, Spinelli A, Bianchi PP, Montorsi M (2007) Contrast-enhanced intraoperative ultrasonography during surgery for hepatocellular carcinoma in liver cirrhosis: is it useful or useless? A prospective cohort study of our experience. Ann Surg Oncol 14:1347–1355
Uchiyama K, Mori K, Tabuse K, Ueno M, Ozawa S, Nakase T, Kawai M, Tani M, Tanimura H, Yamaue H (2008) Assessment of liver function for successful hepatectomy in patients with hepatocellular carcinoma with impaired hepatic function. J Hepatobiliary Pancreat Surg 15:596–602
Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161:346–350
Wakai T, Shirai Y, Sakata J, Kaneko K, Cruz PV, Akazawa K, Hatakeyama K (2007) Anatomic resection independently improves long-term survival in patients with T1–T2 hepatocellular carcinoma. Ann Surg Oncol 14:1356–1365
Gotoh K, Yamada T, Ishikawa O, Takahashi H, Eguchi H, Yano M, Ohigashi H, Tomita Y, Miyamoto Y, Imaoka S (2009) A novel image-guided surgery of hepatocellular carcinoma by indocyanine green fluorescence imaging navigation. J Surg Oncol 100:75–79
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 (2008) Image-guided liver mapping using fluorescence navigation system with indocyanine green for anatomical hepatic resection. World J Surg 32:1763–1767
Tanaka E, Choi HS, Humblet V, Ohnishi S, Laurence RG, Frangioni JV (2008) Real-time intraoperative assessment of the extrahepatic bile ducts in rats and pigs using invisible near-infrared fluorescent light. Surgery 144:39–48
Harada N, Ishizawa T, Muraoka A, Ijichi M, Kusaka K, Shibasaki M, Yamamoto K, Hasegawa K, Bandai Y, Kokudo N (2010) Fluorescence navigation hepatectomy by visualization of localized cholestasis from bile duct tumor infiltration. J Am Coll Surg 210:e2–e6
Ishizawa T, Bandai Y, Ijichi M, Kaneko J, Hasegawa K, Kokudo N (2010) Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy. Br J Surg 97:1369–1377
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Uchiyama, K., Ueno, M., Ozawa, S. et al. Combined intraoperative use of contrast-enhanced ultrasonography imaging using a sonazoid and fluorescence navigation system with indocyanine green during anatomical hepatectomy. Langenbecks Arch Surg 396, 1101–1107 (2011). https://doi.org/10.1007/s00423-011-0778-7
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DOI: https://doi.org/10.1007/s00423-011-0778-7