Identification of Liver Segments Guided by Indocyanine Green Fluorescence Imaging During Anatomical Liver Resections
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Anatomical liver resections (ALR) in the form of segmentectomy or subsegmentectomy require the clear demarcation of the segment volume of parenchyma to be resected. Indocyanine green (ICG) fluorescence achieved through either the positive or the negative staining technique combined with near-infrared (NIR) imaging technology constitutes a real-time intraoperative navigation tool during segmentectomy. The laparoscopic approach in ALR is continuously expanding rendering accurate segment demarcation even more crucial. Yet, ICG fluorescence imaging in laparoscopic ALR is associated with some specific challenges.
In the positive staining technique, ICG is directly injected into the segmental portal vein with the guidance of ultrasonography just before or during surgery. For negative ICG staining, segmental Glissonian pedicles are identified and temporarily occluded with the administration of ICG intravenously during surgery.
The target segment is visualized clearly on the liver surface by either its fluorescence (positive staining) or its distinct absence of fluorescence (negative staining). Its parenchymal boundaries are outlined by the plane between fluorescent and non-fluorescent liver tissue. Therefore, ICG fluorescence renders anatomical liver resections more feasible, accurate, and safe.
KeywordsNear-infrared fluorescence imaging Indocyanine green Anatomical liver resection Subsegmentectomy Cone unit resection Laparoscopic hepatectomy
Laparoscopic S2 subsegmentectomy with ICG fluorescence imaging (M4V 29104 kb)
- 1.Couinaud C. Les enveloppes vasculobiliaries du foie ou capsule de Glisson:leur interet dans la chirurgie vesicularie, les resections hepatiques et l’abord du bile du foie. Lyon Chir. 1954;49:589.Google Scholar
- 2.Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obset. 1985;126:346–50.Google Scholar
- 3.Takayama T, Makuuchi M, Watanabe K, Kosuge T, Takayasu K, Yamazaki S, et al. A new method for mapping hepatic subsegment: counterstaining indetification technique. Surgery. 1991;110:903–4.Google Scholar
- 9.Uchiyama K, Ueno M, Ozawa S, Kiriyama S, Shigekawa Y, Hirono S, et al. Combined intraoperative use of contrast-enhanced ultrasonography imaging using a sonazoid and fluorescence navigation system with indocyanine green during anatomical hepatectomy. Langenbeck's Arch Surg. 2011;396:1101–7. https://doi.org/10.1007/s00423–011–0778–7.CrossRefGoogle Scholar
- 10.Sakoda M, Ueno S, Iino S, Minami K, Ando K, Kawasaki Y, et al. Pure laparoscopic subsegmentectomy of the liver using a puncture method for the target portal branch under percutaneous ultrasound with artificial ascites. Surg Laparosc Endosc Percutan Tech. 2013;23:e45–8. https://doi.org/10.1097/SLE.0b013e31826f9598.CrossRefPubMedGoogle Scholar
- 12.Miyata A, Ishizawa T, Tani K, Shimizu A, Kaneko J, Aoki T, et al. Reappraisal of a dye staining technique for anatomic hepatectomy by the concomitant use of indocyanine green fluorescence imaging. J Am Coll Surg. 2015;221:e27–36. https://doi.org/10.1016/j.jamcollsurg.2015.05.005.CrossRefPubMedGoogle Scholar
- 16.Ueno M, Hayami S, Sonomura T, Tanaka R, Kawai M, Hirono S, et al. Indocyanine green fluorescence imaging techniques and interventional radiology during laparoscopic anatomical liver resection (with video). Surg Endosc. 2018;32:1051–5. https://doi.org/10.1007/s00464–017–5997–8.CrossRefPubMedGoogle Scholar
- 18.Nishino H, Hatano E, Seo S, Nitta T, Saito T, Nakamura M, et al. Real-time navigation for liver surgery using projection mapping with indocyanine green fluorescence: development of the novel medical imaging projection system. Ann Surg. 2018;267:1134–40. https://doi.org/10.1097/SLA.0000000000002172.CrossRefPubMedGoogle Scholar