Indocyanine Green Perfusion Imaging-Guided Laparoscopic Pancreaticoduodenectomy: Potential Application in Retroperitoneal Margin Dissection

  • Seoung Yoon Rho
  • Ji Su Kim
  • Jae Uk Chong
  • Ho Kyoung Hwang
  • Dong Sub Yoon
  • Woo Jung Lee
  • Chang Moo Kang
Multimedia Article
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Abstract

Background

During laparoscopic pancreaticoduodenectomy (LPD), dissecting uncinate process from the superior mesenteric artery (SMA) will determine one of the important surgical margins (retroperitoneal margin) for predicting oncological outcomes and the quality of LPD. However, clear identification of the division line for retroperitoneal margin is not easy as the uncinate process of the pancreas is anatomically very close to SMA and intermingled with the nerve plexus and soft tissues around SMA. In this study, we present data regarding the potential usefulness of indocyanine green (ICG)-enhanced approach in obtaining retroperitoneal margin during LPD.

Methods

From January to September 2017, medical records of patients who underwent LPD for periampullary pathological conditions were retrospectively reviewed. ICG (5 mg/2 cm3) was prepared and intravenously injected when dissecting uncinate process of the pancreas. Perioperative outcomes, including gender, age, diagnosis, body mass index, operation time, estimated blood loss, transfusion, presence of postoperative pancreatic fistulas (POPFs), and length of hospital stay, were evaluated.

Results

During the study period, a total of 37 patients underwent LPD for periampullary pathological lesions. Among them, ICG-enhanced dissection of uncinate process of the pancreas was applied in 10 patients (27%). All patients were able to obtain margin-negative resection. There were no significant differences between the perioperative outcomes of patients who did and did not undergo ICG-enhanced approach.

Discussion

ICG perfusion-based laparoscopic dissection of retroperitoneal margin is feasible and safe in LPD. This intraoperative visual difference can provide the surgeon with very helpful real-time visual information. Further study is mandatory.

Keywords

Laparoscopic pancreaticoduodenectomy Retroperitoneal margin Indocyanine green ICG 

Notes

Author Contributions

Seoung Yoon Rho: Study designing, data analysis, interpretation, writing draft, revising final draft.

Ji Su Kim: Data interpretation, pathologic data handling.

Chang Moo Kang: Study designing, revising final draft, final approval of the version.

Jae Wook Jung, Ho Kyoung Hwang, Dong Sub Yoon, and Woo Jung Lee: data interpretation, revising initial draft.

Supplementary material

11605_2018_3760_MOESM1_ESM.avi (134.2 mb)
ESM 1 (AVI 137406 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  1. 1.Division of Hepatobiliary and Pancreas, Department of SurgeryYonsei University College of MedicineSeoulKorea
  2. 2.Pancreatobiliary Cancer Clinic, Yonsei Cancer Center, Severance HospitalSeoulKorea
  3. 3.Department of SurgeryNational Health Insurance Service Ilsan HospitalGoyangKorea

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