Department of Surgery, Nara Medical University, Kashihara-shi, Nara, Japan.
Ann Surg Oncol. 2018 Dec;25(13):3982. doi: 10.1245/s10434-018-6768-z. Epub 2018 Sep 14.
Among all laparoscopic liver resection techniques, anatomic liver resection is one of the most challenging procedures, with disorientation readily occurring during the laparoscopic approach compared with the open approach.1 Thus, navigation is warranted for laparoscopic anatomic liver resection. Recent research has remarkably established intraoperative fluorescence imaging techniques using indocyanine green fluorescence (ICG) in the field of liver surgery.24 This report describes real-time navigation for anatomic liver resection using the novel ICG system, PINPOINT (Stryker, Kalamazoo, MI).
The target Glissonian pedicle was identified and temporally clamped after confirmation of blood supply to the preserved adjacent segment using ultrasonography. Next, 1.5 mg of ICG was intravenously administered using the negative counterstaining method. After 3 min of administration, the ICG-stained area could be readily recognized. Parenchymal transection was subsequently initiated along the interface between the ICG-positive and ICG-negative areas using the Pringle maneuver.
Using PINPOINT, laparoscopic anatomic liver resection was performed for 16 patients. The extent of liver resection comprised two left hepatectomies, three right-anterior sectionectomies, three right-anterior sectionectomies, and eight segmentectomies. The identification rate of clear demarcations in the ICG images was 100%. The intraoperative blood loss was 226 mL, and the operative time was 305 min. Only one patient encountered the major postoperative complication of ascites, and all the patients attained R0 resection.
Because the images provided by the ICG system are clearer than conventional ICG images, it could facilitate real-time navigation for laparoscopic anatomic liver resection.
在所有腹腔镜肝切除术技术中，解剖性肝切除术是最具挑战性的手术之一，与开放手术相比，腹腔镜手术更容易出现定位偏差。因此，腹腔镜解剖性肝切除术需要导航。最近的研究在肝脏手术领域中使用吲哚菁绿荧光（ICG）显著建立了术中荧光成像技术。本报告描述了使用新型 ICG 系统 PINPOINT（Stryker，Kalamazoo，MI）进行解剖性肝切除术的实时导航。
在使用超声确认保留的相邻节段的血液供应后，确认目标 Glissonian 蒂并临时夹闭。然后，使用负对比染色法静脉注射 1.5 mg ICG。给药 3 分钟后，可轻易识别 ICG 染色区域。随后，沿 ICG 阳性和 ICG 阴性区域之间的界面使用 Pringle 手法启动肝实质离断。
使用 PINPOINT，对 16 名患者进行了腹腔镜解剖性肝切除术。肝切除范围包括 2 例左半肝切除术、3 例右前叶切除术、3 例右前叶切除术和 8 例节段切除术。ICG 图像中清晰界限的识别率为 100%。术中出血量为 226 mL，手术时间为 305 分钟。仅 1 例患者发生腹水的主要术后并发症，所有患者均达到 R0 切除。
由于 ICG 系统提供的图像比常规 ICG 图像更清晰，因此可以促进腹腔镜解剖性肝切除术的实时导航。
