Application of ICG fluorescence navigation in difficult laparoscopic hepatectomy

doi:10.3877/cma.j.issn.2095-3232.2023.04.009

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of indocyanine green (ICG) fluorescence navigation in difficult laparoscopic hepatectomy.

Methods

Clinical data of 51 patients who underwent difficult laparoscopic hepatectomy in the First Affiliated Hospital of University of Science and Technology of China from January, 2019 to April, 2022 were retrospectively analyzed. Among them, 38 patients were male and 13 female, aged from 16 to 77 years, with a median age of 57 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 41 patients were diagnosed with hepatocellular carcinoma, 3 cases of cholangiocarcinoma, 3 cases of mixed liver cancer, 3 casesof focal hyperplasia and 1 case of hemangioma, respectively. All patients were divided into the ICG group (n=25) and control group (n=26) according to whether ICG fluorescence navigation was employed intraoperatively. Perioperative conditions and postoperative complications were observed between two groups.

Results

In the ICG group, the average operation time was (311±88) min, significantly shorter than (385±118) min in the control group (t=-2.538, P<0.05). No significant differences were noted in surgical method, intraoperative blood loss, intraoperative blood transfusion, hepatic portal occlusion time, length of postoperative hospital stay, rate of conversion to open surgery, 90-d reoperation rate and 90-d readmission rate between two groups (all P>0.05). No perioperative death within postoperative 90 d occurred intwo groups. No severe complications ≥ Clavien-Dindo grade Ⅲa were reported. In the ICG group, the incidence of postoperative complications was 16%(4/25), significantly lower than 42%(11/26) in the control group (χ²=4.249, P<0.05).

Conclusions

ICG fluorescence navigation can significantly shorten the operation time and lower the incidence of postoperative complications in difficult laparoscopic hepatectomy, which is expected to provide a safer and simpler surgical option for patients requiring challenging and high-risk laparoscopic hepatectomy.

Key words: Laparoscopes, Hepatectomy, Indocyanine green, Fluorescence imaging, Intraoperative ultrasonography (IOUS)

Yi Zhou, Yifan Wang, Chuanhai Zhang, Jinliang Ma, Jihai Yu, Weidong Jia. Application of ICG fluorescence navigation in difficult laparoscopic hepatectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(04): 407-411.

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Figures/Tables 4

References 22

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组别	例数	年龄（岁，±s）	性别（例）		ASA分级评分（例）		HBsAg阳性（例）	肝硬化（例）	肿瘤直径（cm，±s）
组别	例数	年龄（岁，±s）	男	女	≤2分	>2分	HBsAg阳性（例）	肝硬化（例）	肿瘤直径（cm，±s）
ICG组	25	58±13	16	9	14	11	10	12	5.1±2.6
对照组	26	56±14	22	4	15	11	6	15	6.1±2.9
统计值		t=0.511	χ²=2.852		χ²=0.015		χ²=1.695	χ²=0.481	t=-1.319
P值		0.611	0.091		0.903		0.193	0.488	0.193

组别	例数	年龄（岁，±s）	性别（例）		ASA分级评分（例）		HBsAg阳性（例）	肝硬化（例）	肿瘤直径（cm，±s）
组别	例数	年龄（岁，±s）	男	女	≤2分	>2分	HBsAg阳性（例）	肝硬化（例）	肿瘤直径（cm，±s）
ICG组	25	58±13	16	9	14	11	10	12	5.1±2.6
对照组	26	56±14	22	4	15	11	6	15	6.1±2.9
统计值		t=0.511	χ²=2.852		χ²=0.015		χ²=1.695	χ²=0.481	t=-1.319
P值		0.611	0.091		0.903		0.193	0.488	0.193

组别	例数	手术方式（例）					手术时间（min，±s）	术中出血量[ml，M（Q_R）]	术中输血（例）	肝门阻断时间[min，M（Q_R）]	术后住院时间[min，M（Q_R）]	中转开腹（例）	90 d再手术（例）	90 d再住院（例）
组别	例数	后上段切除	右半肝切除	右前叶切除	右后叶切除	肝中叶切除	手术时间（min，±s）	术中出血量[ml，M（Q_R）]	术中输血（例）	肝门阻断时间[min，M（Q_R）]	术后住院时间[min，M（Q_R）]	中转开腹（例）	90 d再手术（例）	90 d再住院（例）
ICG组	25	17	2	1	4	5	311±88	300（500）	8	30（32）	7（4）	2	0	1
对照组	26	8	9	2	1	2	385±118	450（500）	13	20（45）	8（4）	2	0	2
统计值		χ²=0.692					t=-2.538	Z=-1.244	χ²=1.705	Z=1.182	Z=-1.396	χ²=0.000	-	χ²=0.000
P值		0.406					0.014	0.214	0.192	0.237	0.163	0.999	0.999	0.999

组别	例数	手术方式（例）					手术时间（min，±s）	术中出血量[ml，M（Q_R）]	术中输血（例）	肝门阻断时间[min，M（Q_R）]	术后住院时间[min，M（Q_R）]	中转开腹（例）	90 d再手术（例）	90 d再住院（例）
组别	例数	后上段切除	右半肝切除	右前叶切除	右后叶切除	肝中叶切除	手术时间（min，±s）	术中出血量[ml，M（Q_R）]	术中输血（例）	肝门阻断时间[min，M（Q_R）]	术后住院时间[min，M（Q_R）]	中转开腹（例）	90 d再手术（例）	90 d再住院（例）
ICG组	25	17	2	1	4	5	311±88	300（500）	8	30（32）	7（4）	2	0	1
对照组	26	8	9	2	1	2	385±118	450（500）	13	20（45）	8（4）	2	0	2
统计值		χ²=0.692					t=-2.538	Z=-1.244	χ²=1.705	Z=1.182	Z=-1.396	χ²=0.000	-	χ²=0.000
P值		0.406					0.014	0.214	0.192	0.237	0.163	0.999	0.999	0.999

组别	例数	并发症						Clavien-Dindo分级
组别	例数	胆漏	腹腔积液	肝功能不全	肺部并发症	切口并发症	其它	Ⅰ级	Ⅱ级
ICG组	25	0	1	0	1	0	2	2	2
对照组	26	2	1	3	2	2	1	5	6
χ²值		-	-	1.335	0.000	-	0.001	0.575	1.199
P值		0.490	>0.999	0.248	>0.999	0.490	0.972	0.448	0.274

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