The role of indocyanine green fluorescence imaging in laparoscopic liver surgery

Abstract

Purpose: Indocyanine fluorescence imaging (ICGFI) is increasingly being used to identify biliary anatomy, demarcation of liver transection margins, and blood supply to the remnant liver. However, the role of ICGFI in the identification of site, size and the number of liver tumours is not well established. The purpose of this study is to present our initial experience with ICGFI in laparoscopic liver surgery (LLS). Methods: We present our experience with ICGFI (Stryker Spy Fluorescence technology) guided LLS in four patients between July and November 2020. All patients received a bolus dose of 0.2-0.3ml/kg of ICG intravenously 3-4 hours before surgery Results: Four male patients with a median age of 73.1 (range: 30.6 -85.8) years underwent ICGF guided LLS surgery during the study period. The indication for liver resection was colorectal metastases (CRLM, n=3) and hepatoma (n=1). Patient with HCC had underlying liver fibrosis. ICGFI identified the exact location, size and the number of tumours (median 1; range 1-2). In all four patients the tumour had signet ring appearance (see photo). The tumour's final histology confirmed CRLM in two, the necrotic lesion in one, and HCC in the fourth patient. Interestingly, all three tumours were well to moderately differentiated tumours. ICGFI did not identify any additional lesions. Conclusions: Our initial experience confirms that ICGFI helps identify the site, size, and the number of superficially located colorectal metastasis/hepatomas.