Laparoscopic Liver Resection Enhanced by an Intervention-Guided Fluorescence Imaging Technique Using Sodium Fluorescein.

Chang-Min Lee,Sam-Youl Yoon,Min-Young Jeong

doi:10.3390/jcm10163663

Abstract

Background and Objectives: In laparoscopic liver resections, tumor localization is a critical aspect of ensuring clear resection margins and preserving the hepatic parenchyma. In this study, we designed a fluorescence imaging technique using a new fluorophore for tumor localization. Materials and Methods: Immediately before laparoscopic or transthoracic liver resection, microcatheter was inserted through the hepatic artery and used to engrave the segment containing the tumor in the intervention room. Under blue light, the fluorescence of the lesion was visually confirmed, and the location was determined through intraoperative sonography. After tumor localization, liver resection was performed. Results: From February 2017 to March 2020, 24 patients underwent laparoscopic liver resection (LLR) or video-assisted transthoracic liver resection (VTLR) using intervention-guided fluorescence imaging technique (IFIT). Conclusions: IFIT can provide some advantages in the field of LLR. In addition, in cases of VTLR for hepatocellular carcinoma in the superior posterior segment in patients with marginal liver function, IFIT is considered useful.

Highlights

With the advent of minimally invasive techniques and other medical devices, laparoscopic liver resection (LLR) has been a common procedure since 1992
Several researchers have introduced a near infra-red (NIR) fluorescence imaging technique to create a distinction between liver tumors and their boundaries using indocyanine green (ICG) as a fluorescent tracer during LLR [10,12]
We report the clinical outcomes of LLR or video-assisted transthoracic liver resection (VTLR) in which the tumor-embedding segment was enhanced using an intervention-guided fluorescence imaging technique (IFIT)

Summary

Introduction

With the advent of minimally invasive techniques and other medical devices, laparoscopic liver resection (LLR) has been a common procedure since 1992. If a tumor occurs in an area that is not visualized in the laparoscopic view, tumor-fluorescence does not help to localize the liver tumor In such cases, negative staining technique can be applied in defining the resection range for LLR, it is challenging and time-consuming to expose the portal branches of the targeted hepatic segment. Ueno et al proposed an angiographic perfusion method in which ICG is perfused directly through the arterial branch of the targeted segment as a tracer for angiography and visualized with an NIR fluorescence imaging system [11] We modified this angiographic infusion method to use a different fluorophore in conjunction with preoperative angiography. We report the clinical outcomes of LLR or VTLR in which the tumor-embedding segment was enhanced using an intervention-guided fluorescence imaging technique (IFIT)

Materials and Methods

Discussion