LAPAROSCOPIC LIVER RESECTION WITH FLUORESCENT IMAGING TECHNOLOGY
Takeshi Aoki*, Tomotake Koizumi, Tomokazu Kusano, Kazuhiro Matsuda, Kosuke Yamada, Koji Nogaki, Yoshihiko Tashiro, Yusuke Wada, Tomoki Hakozaki, Hideki Shibata, Kodai Tomioka, Takahito Hirai, Satoru Goto, Kimiyasu Yamazaki, Akira Fujimori, Makoto Watanabe, Osamu Yoshitake, Koji Otsuka, Yuta Enami, Masahiko Murakami
Department of General and Gastroenterological Surgery, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
Background. Fluorescent imaging (FI) technology is a promising imaging in many medical field as a paradigm shift, especially in surgical field for clear visualization of anatomic structure in real time. FI provide the surgeon to visualize only target with hight contrast and easy to use. This study aimed to investigate the feasibility and clinical application of ICG fluorescent imaging, narrow band imaging (NBI) to guide liver surgery.
Methods.Preoperative ultrasonically guided positive tatooing was performed. ICG fluorescent imaging was used intraoperatively during liver resection. During the surgical procedure, the near inferred light (NIR) system (PINPOINT: Stryker, Ellite II, Olympus) was used to assess tumor location, segmentation of liver and surgical margin. Moreover, NBI was performed to access the visualization of vascular patterns in lesions of liver tumor on liver surface.
Results. ICG fluorescent imaging: Total 202 cases of Lap-H (no anatomical liver resection: 150 cases, anatomical liver resection: 52 cases) were performed. FI performed well in superficial and small tumors, but is not unable to visualize deeper tumors (>10 mm from liver surface). In our series, Laparoscopic liver resection (Lap-H) with ICG group achieved R0 status in all cases by the guidance of ICG fluorescence imaging in comparison to four cases of R1 status in Lap-H without Non-ICG group, although no significant difference was found in the surgical margin between two groups. FI is useful to identify the segment or subsegment of liver with positive and negative staining method. Anatomical liver resection were able to perform with staining of liver in all cases. NBI imaging: Tumor vasculature pattern on liver surface which has a different morphology from normal vasculature. NBI can visualize the characteristic morphological features of abnormal vasculature that are observed on high-magnification endoscopy, such as dilatation, heterogeneity in shape, tortuousness, and avascular type.
Conclusion. We strongly believe that image guided technology allow the surgeon to guide real time accurate intraoperative decision making in liver resection.
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