Abstract
PurposeTo explore the role of indocyanine green (ICG) fluorescence navigation in laparoscopic hepatectomy and investigate if the timing of its administration influences the intraoperative observation.MethodsThe 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.ResultsThere 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.ConclusionICG 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.
Highlights
Laparoscopic hepatectomy is performed widely to cure benign and malignant liver diseases [1]
This study showed that the intraoperative and postoperative indexes of the Indocyanine green (ICG)-FN group were comparable to or even better than those of the non-ICG-FN group
Studies have shown that fluorescence navigation can reduce the incidence of bile leakage and liver abscess after hepatic segmentectomy and lobectomy [12], and minimize the postoperative hospital stay [13, 14], this study did not find that ICG fluorescence navigation reduced postoperative complications or the postoperative hospital stay
Summary
Laparoscopic hepatectomy is performed widely to cure benign and malignant liver diseases [1]. 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 last two decades [7]. Laparoscopic hepatectomy using ICG fluorescence navigation is associated with less intraoperative blood loss, a lower transfusion rate, less postoperative complications, and reduced hospital stay, as well as a higher R0 resection rate to avoid a positive surgical margin [12,13,14,15]
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