Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases
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ORIGINAL ARTICLE
Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single‑center study of 120 cases Hao Lu1 · Jian Gu1 · Xiao‑feng Qian1 · Xin‑zheng Dai1 Received: 19 May 2020 / Accepted: 18 August 2020 © The Author(s) 2020
Abstract Purpose To explore the role of indocyanine green (ICG) fluorescence navigation in laparoscopic hepatectomy and investigate if the timing of its administration influences the intraoperative observation. Methods The subjects of this retrospective study were 120 patients who underwent laparoscopic hepatectomy; divided into an ICG-FN group (n = 57) and a non-ICG-FN group (n = 63). We analyzed the baseline data and operative data. Results There were no remarkable differences in baseline data such as demographic characteristics, lesion-related characteristics, and liver function parameters between the groups. Operative time and intraoperative blood loss were significantly lower in the ICG-FN group. The rate of R0 resection of malignant tumors was comparable in the ICG-FN and non-ICG-FN groups, but the wide surgical margin rate was significantly higher in the ICG-FN group. The administration of ICG 0–3 or 4–7 days preoperatively did not affect the intraoperative fluorescence imaging. Operative time, intraoperative blood loss, and a wide surgical margin correlated with ICG fluorescence navigation. ICG fluorescence navigation helped to minimize intraoperative blood loss and achieve a wide surgical margin. Conclusion ICG fluorescence navigation is safe and efficient in laparoscopic hepatectomy. It helps to achieve a wide surgical margin, which could result in a better prognosis. The administration of ICG 0–3 days preoperatively is acceptable. Keywords Laparoscopy · Hepatectomy · Indocyanine green · Navigation
Introduction Laparoscopic hepatectomy is now performed widely to cure benign and malignant liver diseases [1]. To mark the demarcation line, portal staining or inflow clamping of the target area is recommended in conventional open anatomical liver resection [2–4]. Conversely, in laparoscopic hepatectomy, this requires advanced skills. The lack of tactile perception of laparoscopic forceps and the complexity of intraoperative ultrasound examination makes it challenging to localize the tumor and confirm the demarcation line, limiting the application of this technology [5]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02163-8) contains supplementary material, which is available to authorized users. * Xin‑zheng Dai [email protected] 1
Hepatobiliary Center, First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu, China
Indocyanine green (ICG), once bound to protein, can emit fluorescence (peaking at 840 nm) under the illumination of near-infrared light [6]. Because it can be absorbed exclusively by hepatocytes and excreted through bile without enterohepatic recirculation, ICG has gain the attention of hepatobiliary surgeons over the las
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