What is a precise anatomic resection of the liver? Proposal of a new evaluation method in the era of fluorescence navigation surgery
What is a precise anatomic resection of the liver? Proposal of a new evaluation method in the era of fluorescence navigation surgery
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DOI：
10.1002/jhbp.824
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发表时间：
2020-10-04
影响因子：
3
通讯作者：
Uemoto, Shinji
中科院分区：
文献类型：
--
作者：
Nishino, Hiroto;Seo, Satoru;Uemoto, Shinji
背景/目的吲哚菁绿 (ICG) 荧光导航已适用于解剖性肝切除术 (AR)，但需要一种客观的方法来评估其有效性。这项试点研究旨在提出一种新方法来评估沿肝段之间平面的实质划分的准确性，并评估医学成像投影系统（MIPS）对 AR 的实时导航效果，该系统使用 ICG 荧光投影映射连续演示横断面。方法 纳入 2016 年 8 月至 2019 年 7 月期间采用 ICG 荧光技术肝脏分割进行开放 AR 的 10 例患者：6 例在 MIPS 指导下（MIPS 组），4 例在实质切除前仅使用常规 ICG 荧光技术（非 MIPS 组）。对捕获的荧光图像进行光密度测定，以评估每个横断面的荧光面积比。通过从剩余侧的荧光面积率中减去切除侧的荧光面积率来计算准确的荧光面积率。结果 MIPS 组和非 MIPS 组的准确荧光面积比分别为 23.0 +/- 12.6% 和 5.6 +/- 9.5% (P = .038)。结论 根据我们新方法的结果，使用 MIPS 进行实时导航可能有助于沿着肝段之间的平面执行 AR。
Background/Purpose Indocyanine green (ICG) fluorescence navigation has been adapted for anatomic liver resection (AR) but an objective method for evaluation of its validity is required. This pilot study aimed to propose a new method to evaluate the accuracy of parenchymal division along the plane between hepatic segments and estimate the real-time navigation efficacy for AR by the Medical Imaging Projection System (MIPS), which continuously demonstrates the transection plane using projection mapping with ICG fluorescence. Methods Ten patients who underwent open AR using liver segmentation with ICG fluorescence technique between August 2016 and July 2019 were included: six patients under MIPS guidance (MIPS group), while four using only conventional ICG fluorescence technique before parenchymal resection (non-MIPS group). Densitometry of the captured fluorescence image was performed to evaluate the fluorescence area ratio of each transection plane. The accurate fluorescence area ratio was calculated by subtracting the fluorescence area rate on the resected side from that on the remnant side. Results The accurate fluorescence area ratio of the MIPS group and the non-MIPS group was 23.0 +/- 12.6% and 5.6 +/- 9.5%, respectively (P = .038). Conclusions Based on the results of our new method, real-time navigation using the MIPS may facilitate performing AR along the plane between hepatic segments.