Diana Michele, Liu Yu-Yin, Pop Raoul, Kong Seong-Ho, Legnèr Andras, Beaujeux Remy, Pessaux Patrick, Soler Luc, Mutter Didier, Dallemagne Bernard, Marescaux Jacques
IRCAD, Research Institute Against Cancer of the Digestive System, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
Surg Endosc. 2017 Mar;31(3):1451-1460. doi: 10.1007/s00464-016-5136-y. Epub 2016 Aug 5.
Intraoperative liver segmentation can be obtained by means of percutaneous intra-portal injection of a fluorophore and illumination with a near-infrared light source. However, the percutaneous approach is challenging in the minimally invasive setting. We aimed to evaluate the feasibility of fluorescence liver segmentation by superselective intra-hepatic arterial injection of indocyanine green (ICG).
Eight pigs (mean weight: 26.01 ± 5.21 kg) were involved. Procedures were performed in a hybrid experimental operative suite equipped with the Artis Zeego, multiaxis robotic angiography system. A pneumoperitoneum was established and four laparoscopic ports were introduced. The celiac trunk was catheterized, and a microcatheter was advanced into different segmental hepatic artery branches. A near-infrared laparoscope (D-Light P, Karl Storz) was used to detect the fluorescent signal. To assess the correspondence between arterial-based fluorescence demarcation and liver volume, metallic markers were placed along the fluorescent border, followed by a 3D CT-scanning, after injecting intra-arterial radiological contrast (n = 3). To assess the correspondence between arterial and portal supplies, percutaneous intra-portal angiography and intra-arterial angiography were performed simultaneously (n = 1).
Bright fluorescence signal enhancing the demarcation of target segments was obtained from 0.1 mg/mL, in matter of seconds. Correspondence between the volume of hepatic segments and arterial territories was confirmed by CT angiography. Higher background fluorescence noise was found after positive staining by intra-portal ICG injection, due to parenchymal accumulation and porto-systemic shunting.
Intra-hepatic arterial ICG injection, rapidly highlights hepatic target segment borders, with a better signal-to-background ratio as compared to portal vein injection, in the experimental setting.
术中肝脏分割可通过经皮门静脉注射荧光团并用近红外光源照射来实现。然而，在微创环境下经皮途径具有挑战性。我们旨在评估通过超选择性肝内动脉注射吲哚菁绿（ICG）进行荧光肝脏分割的可行性。
纳入8头猪（平均体重：26.01±5.21千克）。手术在配备Artis Zeego多轴机器人血管造影系统的混合实验手术室中进行。建立气腹并插入四个腹腔镜端口。对腹腔干进行插管，并将微导管推进到不同的肝段动脉分支。使用近红外腹腔镜（Karl Storz公司的D-Light P）检测荧光信号。为了评估基于动脉的荧光分界与肝脏体积之间的对应关系，在动脉内注射放射造影剂后（n = 3），沿着荧光边界放置金属标记物，随后进行三维CT扫描。为了评估动脉和门静脉供血之间的对应关系，同时进行经皮门静脉血管造影和动脉内血管造影（n = 1）。
在数秒内从0.1毫克/毫升的浓度获得了增强目标段分界的明亮荧光信号。CT血管造影证实了肝段体积与动脉区域之间的对应关系。由于实质内积聚和门体分流，门静脉注射ICG阳性染色后发现背景荧光噪声较高。
在实验环境中，肝内动脉注射ICG能快速突出肝脏目标段边界，与门静脉注射相比，具有更好的信噪比。
