Indocyanine green fluorescence imaging techniques and interventional radiology during laparoscopic anatomical liver resection (with video)
Indocyanine green fluorescence imaging techniques and interventional radiology during laparoscopic anatomical liver resection (with video)
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DOI：
10.1007/s00464-017-5997-8
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发表时间：
2018-02-01
影响因子：
3.1
通讯作者：
Yamaue, Hiroki
中科院分区：
文献类型：
--
作者：
Ueno, Masaki;Hayami, Shinya;Yamaue, Hiroki
背景 为了完成腹腔镜解剖性肝切除术，术中肝脏分割是必要的。纹身法或格里森法的使用方式与开腹肝切除术类似。此外，在肝段检测中，吲哚菁绿（ICG）的荧光意味着它已被认为是一种有用的染料。然而，在腹腔镜检查中，执行这些传统方法存在技术困难，因此需要开发新技术来识别肝段。我们报告了一项利用介入放射学技术进行腹腔镜术中肝脏分割的初步研究。方法在肝实质切除之前，使用混合手术室进行血管造影。将导管从右股动脉插入目标动脉分支。通过动脉造影确认灌注面积后，注入含有ICG的栓塞液，对分支进行栓塞。采用近红外成像系统PINPOINT观察ICG荧光。结果注射栓塞液后，立即在待切除的肝脏表面观察到ICG荧光。这种视觉效果在肝实质切除过程中持续存在。我们能够通过观察切除侧切面的ICG荧光来确认实质内边界，并完成精确的解剖性肝脏切除。结论我们的新技术为腹腔镜解剖性肝脏切除性能提供了进步。由于二维腹腔镜缺乏深度感知，额外的视觉信息（例如 ICG 荧光图像）有助于作为精确腹腔镜解剖肝切除术的导航工具。
Background To accomplish laparoscopic anatomical liver resection, intraoperative liver segmentation is necessary. Tattooing method or Glissonian approach will be used in a similar way to that in open liver resection. Moreover, in liver segment detection, the fluorescence of indocyanine green (ICG) means it has been recognized as a useful dye. In laparoscopy, however, there are technical difficulties in performing these conventional methods, so development of new techniques is necessary for liver segment identification. We report a pilot study using interventional radiology technique for laparoscopic intraoperative liver segmentation.Methods Just prior to liver parenchymal resection, angiography was performed using a hybrid operation room. A catheter was inserted from the right femoral artery into the targeted arterial branch. After confirming the perfusion area by arteriography, embolic solution containing ICG was injected, and the branch was embolized. ICG fluorescence was observed by PINPOINT, a near-infrared imaging system.Results Immediately after embolic solution injection, we were able to observe ICG fluorescence on the surface of the liver to be resected. This visual effect continued during liver parenchymal resection. We were able to confirm the intra-parenchymal boundary by observing ICG fluorescence on the cut surface of the resecting side and accomplished precise anatomical liver resection.Conclusions Our novel technique provides advances in laparoscopic anatomical liver resection performance. As two-dimensional laparoscopy lacks depth perception, additional visual information, such as ICG fluorescence imagery, is helpful as a navigation tool for precise laparoscopic anatomical liver resection.