Laparoscopic anatomical liver resection guided by real-time indocyanine green fluorescence imaging: experience and lesso
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and Other Interventional Techniques
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Laparoscopic anatomical liver resection guided by real‑time indocyanine green fluorescence imaging: experience and lessons learned from the initial series in a single center Yinzhe Xu1 · Mingyi Chen1 · Xiangfei Meng1 · Peng Lu1 · Xun Wang1 · Wenwen Zhang1 · Ying Luo1 · Weidong Duan1 · Shichun Lu1 · Hongguang Wang1 Received: 8 March 2020 / Accepted: 27 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Anatomical liver resection is an established procedure for primary hepatic tumors. Laparoscopic anatomical hepatectomy has been proven to be technically achievable from S1 to S8 in experienced hands. The indocyanine green (ICG) fluorescence imaging technique offers a novel tool of intraoperative visualization in hepatobiliary surgery. This study aims to investigate the feasibility of laparoscopic anatomical liver resection based on segmental staining using real-time ICG fluorescence. Methods From December 2015 to October 2017, 36 patients in our institute underwent lap-ALR using real-time ICG fluorescence mapping of the tumor-bearing portal territory. The procedural and perioperative data were collected and analyzed. Results In our case series, we successfully performed the fashion of positive staining mostly in segmentectomy or sub-segmentectomy by individually injecting 5–10 ml of ICG (0.025 mg/ml) into its feeding portal branch guided by intraoperative ultrasound, and the negative staining mainly for sectionectomy, hemihepatectomy and multi-segmentectomy by interrupting the Glissonean pedicle serving the tumor-bearing segments and systemically injecting 1 ml of ICG (2.5 mg/ml). Our total successful rate of staining is 53%. No conversion to laparotomy, Clavien III–IV complication or 90-day mortality occurred. Valuable technical feedback, experience and lessons are learned from this initial practice. Conclusions Real-time ICG fluorescence imaging adds much precision to laparoscopic anatomical hepatectomy. The success of segmental staining requires a high proficiency of IOUS and skillful interpretation of preoperative 3D simulation. Decision-making on the fashions of positive and negative staining have been initially recommended. Multi-centered practice and technical modification are necessary to standardize its application. Keywords Laparoscopic · Anatomical liver resection · Indocyanine green · Infrared fluorescence · Intraoperative ultrasound
Yinzhe Xu and Mingyi Chen have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07691-5) contains supplementary material, which is available to authorized users. * Shichun Lu [email protected] * Hongguang Wang [email protected] 1
Department of Hepatobiliary Surgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing 100853, China
Anatomical liver resection (ALR) is an established procedure for primary liver tumors, featuring the
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