Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Pancreatobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea.
J Gastrointest Surg. 2018 Aug;22(8):1470-1474. doi: 10.1007/s11605-018-3760-7. Epub 2018 Apr 9.
During laparoscopic pancreaticoduodenectomy (LPD), dissecting uncinate process from the superior mesenteric artery (SMA) will determine one of the important surgical margins (retroperitoneal margin) for predicting oncological outcomes and the quality of LPD. However, clear identification of the division line for retroperitoneal margin is not easy as the uncinate process of the pancreas is anatomically very close to SMA and intermingled with the nerve plexus and soft tissues around SMA. In this study, we present data regarding the potential usefulness of indocyanine green (ICG)-enhanced approach in obtaining retroperitoneal margin during LPD.
From January to September 2017, medical records of patients who underwent LPD for periampullary pathological conditions were retrospectively reviewed. ICG (5 mg/2 cm) was prepared and intravenously injected when dissecting uncinate process of the pancreas. Perioperative outcomes, including gender, age, diagnosis, body mass index, operation time, estimated blood loss, transfusion, presence of postoperative pancreatic fistulas (POPFs), and length of hospital stay, were evaluated.
During the study period, a total of 37 patients underwent LPD for periampullary pathological lesions. Among them, ICG-enhanced dissection of uncinate process of the pancreas was applied in 10 patients (27%). All patients were able to obtain margin-negative resection. There were no significant differences between the perioperative outcomes of patients who did and did not undergo ICG-enhanced approach.
ICG perfusion-based laparoscopic dissection of retroperitoneal margin is feasible and safe in LPD. This intraoperative visual difference can provide the surgeon with very helpful real-time visual information. Further study is mandatory.
在腹腔镜胰十二指肠切除术（LPD）中，从肠系膜上动脉（SMA）解剖钩突将确定预测肿瘤学结果和 LPD 质量的重要手术边界之一（腹膜后边界）。然而，由于胰腺的钩突在解剖上非常接近 SMA 并且与 SMA 周围的神经丛和软组织交织在一起，因此不易明确识别腹膜后边界的分界线。在这项研究中，我们提供了有关吲哚菁绿（ICG）增强方法在 LPD 中获得腹膜后边界的潜在有用性的数据。
从 2017 年 1 月至 9 月，回顾性分析了因壶腹周围病变而行 LPD 的患者的病历。当解剖胰腺的钩突时，将 ICG（5mg/2cm）准备并静脉内注射。评估围手术期结果，包括性别、年龄、诊断、体重指数、手术时间、估计失血量、输血、术后胰腺瘘（POPF）的存在以及住院时间。
在研究期间，共有 37 例患者因壶腹周围病变而行 LPD。其中，10 例（27%）患者接受了 ICG 增强的钩突解剖。所有患者均能获得阴性切缘的切除。接受和不接受 ICG 增强方法的患者之间的围手术期结果无显着差异。
在 LPD 中，基于 ICG 灌注的腹腔镜腹膜后边界解剖是可行且安全的。这种术中的视觉差异可以为外科医生提供非常有帮助的实时视觉信息。需要进一步研究。
