Ultrasonography-guided hepatic tumor resection using a real-time virtual sonography with indocyanine green navigation (with videos)
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For hepatic tumors that cannot be identified on routine ultrasonography (US), we marked the target area using real-time virtual sonography (RVS) with indocyanine green (ICG)–ethanol (1:100) during surgery, and performed hepatic resection while observing the fluorescence.
An ICG–ethanol mixture locally injected into mouse liver was retained in the same area for more than 4 h. The same mixture locally injected into pig liver at a depth of 3 cm could be observed using an infrared camera.
An ICG–ethanol mixture (500 μl) was locally injected under RVS guidance into a metastatic hepatic tumor that was visible only on magnetic resonance imaging (MRI), and hepatic resection was performed while Photodynamic Eye (PDE) images were being observed. The metastatic lesion (3 mm in diameter in a pathological specimen) could be successfully resected.
This method was useful for resecting US-invisible hepatic tumors.
KeywordsLiver Navigation surgery Real-time virtual sonography Indocyanine green
This study was supported by a clinical research grant from the Cancer Center of Tokyo Medical University.
Video 1 The needle stab was performed after synchronizing the MRI and US images in a respiratory arrest condition. The ICG solution was located as a strong circular echo (MPG 2777 kb)
Video 2 As the strong fluorescence meant that the operating room did not have to be dark, the PDE scan was performed in normal light. Therefore the operator was able to work without stress while watching the PDE (MPG 2775 kb)
Video 3 The fluorescence was visible at the hepatic surface through the non-fluorescent liver. The injected ICG emitted spherical (circular in the hepatic cut section) fluorescence at the tip of the needle and along the stab line of the needle on the hepatic cut section (MPG 1738 kb)
- 2.Stippel DL, Böhm S, Beckurts KT, Brochhagen HG, Hölscher AH. Intraoperative radiofrequency ablation using a 3D navigation tool for treatment of colorectal liver metastases. Onkologie 2002;25:346–50.Google Scholar
- 10.Alberts RS, Horvath WL, Sternfeld WC, Goldberg RM, Mahoney MR, Dakhil SR, et al. Oxaliplatin, fluorouracil, and leucovorin for patients with unresectable liver-only metastases from colorectal cancer: a North Central Cancer Treatment Group Phase II Study. J Clin Oncol. 2005;23:9243–9.PubMedCrossRefGoogle Scholar
- 12.Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, et al. Australasian Gastro-Intestinal Trials Group (AGITG). Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–16.PubMedCrossRefGoogle Scholar