To evaluate clinical efficacy and safety of ICG fluorescence imaging in laparoscopic hepatectomy of hepatocellular carcinoma (HCC).

Clinical data of 47 patients who underwent laparoscopic hepatectomy of HCC in the Third Affiliated Hospital of Sun Yat-sen University from January 2023 to January 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 40 patients were male and 7 female, aged (57±11) years on average. All patients were divided into ICG group (n=21) and traditional group (n=26) according to whether ICG fluorescence imaging was used. Operation time and intraoperative blood loss between two groups were compared by rank-sum test. Tumor margin and the incidence of postoperative complications between two groups were compared by Chi-square test or Fisher’s exact test.

All HCC patients in two groups underwent laparoscopic hepatectomy without conversion to open surgery. In the ICG group, the tumor margin was ≥1 cm in 16 cases and 7 cases in the traditional group, and the difference was statistically significant (χ²=11.284, P<0.05). In the ICG group, the operation time, intraoperative blood loss and the length of postoperative hospital stay were 163 (140, 198) min, 50 (50, 100) ml and 4.0 (4.0, 5.5) d, respectively, compared with 170 (134, 226) min, 50 (28,100) ml and 5.5 (3.0,7.0) d in traditional group, and the differences were not statistically significant (Z=0.857, 0.801, -1.083; all P>0.05). In the ICG group, no postoperative bile leakage and 1 case of peritoneal effusion was observed, while 4 and 0 in the traditional group, and the difference was not statistically significant (both P>0.05).

Compared with traditional laparoscopic resection of HCC, ICG fluorescence imaging can assist surgeons to obtain more favorable tumor margin without prolonging operation time or increasing surgical risk.