Augmented reality combined with ICG molecular fluorescence imaging-navigated 3D laparoscopic right hepatectomy (video attached)

Abstract

Objective To explore the feasibility and safety of 3D laparoscopic right hepatectomy guided by augmented reality (AR) combined with indocyanine green (ICG) molecular fluorescence imaging technology. Methods One patient with liver cancer who underwent 3D laparoscopic right hepatectomy navigated by AR combined with ICG molecular fluorescence imaging in Zhujiang Hospital of Southern Medical University in April 2019 was enrolled in this study. The male patient, aged 56 years, was diagnosed with stage Ⅰb primary liver cancer according to Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition). The informed consent of the patient was obtained and the local ethical committee approval was received. Preoperative evaluation and virtual hepatectomy were performed by 3D visualization technology. The 3D laparoscopic right hepatectomy was performed through 5-port approach. The images of 3D models and 3D laparoscopic right hepatectomy were fused in a real-time manner by AR technology. Hepatectomy was conducted with real-time navigation, combining with ICG molecular fluorescence imaging technology. Intraoperative and postoperative conditions of the patient were observed. Results Preoperative 3D visual evaluation demonstrated that the tumor was mainly located in the segments Ⅶ and Ⅷ, compressing the right hepatic vein. In addition, variations were observed in the hepatic artery. The right hepatic artery originated from the superior mesenteric artery. Virtual right hepatectomy simulation showed that the resected liver volume was 796.6 ml, and the remaining liver volume was 529.0 ml, accounting for 40% of the total liver volume. Intraoperatively, AR and ICG molecular fluorescence imaging technologies were employed to identify no metastatic lesions on the liver surface. The liver resection surface was marked along the fluorescence demarcation line, which was consistent with the ischemia line. The operation was completed successfully. The operation time was 360 min and intraoperative blood loss was 250 ml. Postoperative pathological examination confirmed the diagnosis of hepatocellular carcinoma. No severe complications, such as hemorrhage, bile leakage and liver failure, occurred after the operation. The length of postoperative hospital stay was 7 d. Conclusions AR combined with ICG molecular fluorescence imaging technology-navigated 3D laparoscopic right hepatectomy is safe and feasible, which has high clinical application value. Key words: Augmented reality; Indocyanine green; Fluorescence; Imaging, three-dimensional; Laparoscopes; Hepatectomy