Skip to main content
SpringerLink
Log in

A new method of near-infrared fluorescence image-guided hepatectomy for patients with hepatolithiasis: a randomized controlled trial

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Hepatectomy is a definitive treatment for hepatolithiasis because it simultaneously removes intrahepatic duct (IHD) stones and biliary tract strictures together with the involved liver region en bloc. Unlike cystic or solid liver tumors, hepatolithiasis is usually associated with alterations of anatomical structures and perihepatic adhesions because of chronic recurrent inflammation. This complicates identification of the target hepatic region and location of biliary strictures.

Methods

To determine the efficacy of near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG), we performed a comparative trial and developed a white-light and near-infrared dual-channel image-guided device (DPM-I) for both open and endoscopic surgery. Forty-four eligible patients were randomly assigned to Group A (NIRF imaging) or Group B (traditional hepatectomy). We injected ICG via peripheral veins for patients in Group A.

Results

The NIRF imaging method was associated with less blood loss (OR 1.004, 95% CI 0.999–1.010; P = 0.016), briefer hospitalization (OR 1.336, 95% CI 1.016–1.756; P = 0.001), lower rates of margins with dilated bile ducts (OR 1.278, 95% CI 1.030–1.585; P = 0.023), lower postoperative white blood cell counts (OR 1.262, 95% CI 0.931–1.712; P = 0.038), lower procalcitonin levels (OR 1.316, 95% CI 1.020–1.513; P = 0.002), and lower alanine aminotransferase levels (OR 1.013, 95% CI 1.003–1.023; P = 0.002) compared with traditional hepatectomy.

Conclusions

These data demonstrate the efficacy of NIRF imaging with ICG using DPM-I for treating hepatolithiasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Li EL, Yuan RF, Liao WJ, Feng Q, Lei J, Yin XB, Wu LQ, Shao JH (2019) Intrahepatic bile duct exploration lithotomy is a useful adjunctive hepatectomy method for bilateral primary hepatolithiasis: an eight-year experience at a single centre. BMC Surg 19(1):16

    Article  Google Scholar 

  2. Amar N, Al-Ozaibi L, Badri F (2019) Hepatolithiasis: a case report and literature review. Hamdan Med J 12:86

    Article  Google Scholar 

  3. Peng JX, Wang LZ, Diao JF, Tan ZJ, Zhong XS, Zhen ZP, Chen GH, He JM (2018) Major hepatectomy for primary hepatolithiasis: a comparative study of laparoscopic versus open treatment. Surg Endosc 32:4271–4276

    Article  Google Scholar 

  4. Liu XH, Min XC, Ma Z, He XD, Du ZX (2018) Laparoscopic hepatectomy produces better outcomes for hepatolithiasis than open hepatectomy: an updated systematic review and meta-analysis. Int J Surg 51:151–163

    Article  Google Scholar 

  5. Kim HJ, Kim JS, Joo MK, Lee BJ, Kim JH, Yeon JE, Park JJ, Byun KS, Bak YT (2015) Hepatolithiasis and intrahepatic cholangiocarcinoma: a review. World J Gastroenterol 21:13418–13431

    Article  CAS  Google Scholar 

  6. Park HM, Hur YH, Cho CK, Koh YS, Kim HJ, Park EK (2016) Incidence of underlying biliary neoplasm in patients after major hepatectomy for preoperative benign hepatolithiasis. Ann Hepatobiliary Pancreat Surg 20:173–179

    Article  Google Scholar 

  7. Ding GQ, Cai W, Qin MF (2015) Pure laparoscopic versus open liver resection in treatment of hepatolithiasis within the left lobes: a randomized trial study. Surg Laparosc Endosc Percus 25:392–394

    Article  Google Scholar 

  8. Kim YK, Han HS, Yoon YS, Cho JY, Lee W (2015) Laparoscopic approach for right-sided intrahepatic duct stones: a comparative study of laparoscopic versus open treatment. World J Surg 39:1224–1230

    Article  Google Scholar 

  9. Ye XM, Ni KY, Zhou XS, Xie KG, Hong XM (2015) Laparoscopic versus open left hemihepatectomy for hepatolithiasis. J Surg Res 199:402–406

    Article  Google Scholar 

  10. Li EL, Feng Q, Yang QP, Liao WJ, Liu WW, Huang Y, Wu LQ, Yin XB, Shao JH (2017) Effectiveness of hepatic parenchyma lithotomy of hepatolithiasis: a single-center experience. Medicine 96(10):e6134

    Article  Google Scholar 

  11. Shin YC, Jang JY, Kang MJ, Jung W, Chang J, Chang YR, Kim SW (2016) Comparison of laparoscopic versus open left-sided hepatectomy for intrahepatic duct stones. Surg Endosc 30:259–265

    Article  Google Scholar 

  12. Tan JW, Tan YC, Chen F, Zhu YL, Leng JJ, Dong JH (2015) Endoscopic or laparoscopic approach for hepatolithiasis in the era of endoscopy in China. Surg Endosc 29:154–162

    Article  Google Scholar 

  13. Li C, Wen TF (2017) Surgical management of hepatolithiasis: a minireview. Intractable Rare Dis Res 6:102–105

    Article  Google Scholar 

  14. Nguyen QT, Tsien RY (2013) Fluorescence-guided surgery with live molecular navigation—A new cutting edge. Nat Rev Cancer 13:653–662

    Article  CAS  Google Scholar 

  15. Nguyen DP, Huber PM, Metzger TA, Genitsch V, Schudel HH, Thalmann GN (2016) A specific mapping study using fluorescence sentinel lymph node detection in patients with intermediate- and high-risk prostate cancer undergoing extended pelvic lymph node dissection. Eur Urol 70:734–737

    Article  Google Scholar 

  16. Ahmed M, Purushotham AD, Douek M (2014) Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol 15:E351–E362

    Article  Google Scholar 

  17. Sakurai T, Endo M, Shimizu K, Yoshimizu N, Nakajima K, Nosaka K, Dai Y, Iwao A, Jinnai Y (2014) Axillary reverse mapping using fluorescence imaging is useful for identifying the risk group of postoperative lymphedema in breast cancer patients undergoing sentinel node biopsies. J Surg Oncol 109:612–615

    Article  Google Scholar 

  18. van der Vorst JR, Schaafsma BE, Hutteman M, Verbeek FPR, Liefers GJ, Hartgrink HH, Smit V, Lowik C, van de Velde CJH, Frangioni JV, Vahrmeijer AL (2013) Near-infrared fluorescence-guided resection of colorectal liver metastases. Cancer 119:3411–3418

    Article  Google Scholar 

  19. Degett TH, Andersen HS, Gogenur I (2016) Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbeck Arch Surg 401:767–775

    Article  Google Scholar 

  20. He KS, Zhou J, Yang F, Chi CW, Li H, Mao YM, Hui BG, Wang K, Tian J, Wang J (2018) Near-infrared intraoperative imaging of thoracic sympathetic nerves: from preclinical study to clinical trial. Theranostics 8:304–313

    Article  CAS  Google Scholar 

  21. 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

    Article  Google Scholar 

  22. Yokoyama N, Otani T, Hashidate H, Maeda C, Katada T, Sudo N, Manabe S, Ikeno Y, Toyoda A, Katayanagi N (2012) Real-time detection of hepatic micrometastases from pancreatic cancer by intraoperative fluorescence imaging preliminary results of a prospective study. Cancer 118:2813–2819

    Article  CAS  Google Scholar 

  23. Inoue Y, Arita J, Sakamoto T, Ono Y, Takahashi M, Takahashi Y, Kokudo N, Saiura A (2015) Anatomical liver resections guided by 3-dimensional parenchymal staining using fusion indocyanine green fluorescence imaging. Ann Surg 262:105–111

    Article  Google Scholar 

  24. Mizuno S, Isaji S (2010) Indocyanine green (icg) fluorescence imaging-guided cholangiography for donor hepatectomy in living donor liver transplantation. Am J Transpl 10:2725–2726

    Article  CAS  Google Scholar 

  25. Kaibori M, Ishizaki M, Matsui K, Kwon AH (2011) Intraoperative indocyanine green fluorescent imaging for prevention of bile leakage after hepatic resection. Surgery 150:91–98

    Article  Google Scholar 

  26. He KS, Chi CW, Kou DQ, Huang WH, Wu JD, Wang YB, He LF, Ye JZ, Mao YM, Zhang GJ, Wang JD, Tian J (2016) Comparison between the indocyanine green fluorescence and blue dye methods for sentinel lymph node biopsy using novel fluorescence image-guided resection equipment in different types of hospitals. Transl Res 178:74–80

    Article  CAS  Google Scholar 

  27. Mao YM, Wang K, He KS, Ye JZ, Yang F, Zhou J, Li H, Chen XY, Wang J, Chi CW, Tian J (2017) Development and application of the near-infrared and white-light thoracoscope system for minimally invasive lung cancer surgery. J Biomed Opt 22(6):66002

    Article  Google Scholar 

  28. Chi C, Du Y, Ye J, Kou D, Qiu J, Wang J, Tian J, Chen X (2014) Intraoperative imaging-guided cancer surgery: from current fluorescence molecular imaging methods to future multi-modality imaging technology. Theranostics 4:1072–1084

    Article  Google Scholar 

  29. Huang LY, Vore M (2001) Multidrug resistance P-glycoprotein 2 is essential for the biliary excretion of indocyanine green. Drug Metab Dispos 29:634–637

    CAS  PubMed  Google Scholar 

  30. De Graaf W, Häusler S, Heger M, van Ginhoven TM, van Cappellen G, Bennink RJ, Kullak-Ublick GA, Hesselmann R, van Gulik TM, Stieger B (2011) Transporters involved in the hepatic uptake of 99mTc-mebrofenin and indocyanine green. J Hepatol 54:738–745

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by the Ministry of Science and Technology of the People’s Republic of China (MOST) (2017YFA0205200, 2017YFA0700401, 2016YFA0100902, 2019YFC0120800), National Natural Science Foundation of China (NSFC) (81527805, 81971773), Key Research Projects in Frontier Science of Chinese Academy of Sciences (CAS) (QYZDJ-SSW-JSC005, KFJ-STS-ZDTP-059), Natural Science Foundation of Guangdong Province of China (2018A0303130292, 2019A1515011356), and Project of Administration of Traditional Chinese Medicine of Guangdong Province of China (20181062), China Postdoctoral Science Foundation (2019M660409). The Clinical Trails was registered with the name of Near-infrared Fluorescence Imaging Applied in Hepatolithiasis with Indocyanine Green, and No. ChiCTR1800020031. http://www.chictr.org.cn/showproj.aspx?proj=32467.

Author information

Author notes

  1. Kunshan He, Xiaopeng Hong, and Chongwei Chi contributed equally to this work and should be considered as co-first authors.

Authors and Affiliations

  1. The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China

    Kunshan He, Xiaopeng Hong, Chaonong Cai, Peiping Li, Xialei Liu, Jian Li & Hong Shan

  2. Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, 100191, China

    Kunshan He & Jie Tian

  3. Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China

    Chongwei Chi, Kun Wang & Jie Tian

Authors
  1. Kunshan He
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaopeng Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chongwei Chi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chaonong Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peiping Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xialei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jian Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hong Shan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jie Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jian Li, Hong Shan or Jie Tian.

Ethics declarations

Disclosures

Kunshan He, Xiaopeng Hong, Chongwei Chi, Chaonong Cai, Kun Wang, Peiping Li, Xialei Liu, Jian Li, Hong shan, and Jie Tian have no conflict of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 220 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

He, K., Hong, X., Chi, C. et al. A new method of near-infrared fluorescence image-guided hepatectomy for patients with hepatolithiasis: a randomized controlled trial. Surg Endosc 34, 4975–4982 (2020). https://doi.org/10.1007/s00464-019-07290-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-07290-z

Keywords

Search

Navigation