Usefulness of ICG Fluorescence Imaging in Laparoscopic Liver Resection

Abstract

Laparoscopic liver resection (LLR) is now widely used as a minimally invasive surgical option for benign and malignant liver disease. Recent advances in LLR technique and instrumentation have enabled various procedures, including anatomic resection in liver surgery. However, the endoscopic approach is limited by its two-dimensional view, the absence of tactile sense, and the difficulty in establishing anatomic orientation, due to the use of a magnified view. Indocyanine green (ICG) fluorescence imaging is a tool for real-time surgical navigation in hepatobiliary surgery. It is useful in identifying anatomic portal parenchymal territory, localizing liver tumors, and detecting bile leakage during open liver surgery. With the development of laparoscopic fluorescence imaging systems, this technology can now be used for LLR. As LLR is increasingly adopted for treatment of liver disease, uptake of intraoperative real-time image guidance systems is likely to accelerate. The ICG fluorescence imaging system will be helpful as a surgical “third eye” in ensuring safe and precise LLR.