Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
J Hepatobiliary Pancreat Sci. 2021 Jun;28(6):479-488. doi: 10.1002/jhbp.824. Epub 2020 Oct 4.
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.
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.
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).
Based on the results of our new method, real-time navigation using the MIPS may facilitate performing AR along the plane between hepatic segments.
背景/目的：吲哚菁绿（ICG）荧光导航已被应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。本研究旨在提出一种新的方法来评估沿肝段之间平面进行实质分割的准确性，并通过 Medical Imaging Projection System（MIPS）实时评估 AR 的导航效果，该系统使用 ICG 荧光投影映射连续显示横断平面。
纳入 2016 年 8 月至 2019 年 7 月期间接受使用 ICG 荧光技术进行肝分段的开放 AR 的 10 例患者：6 例在 MIPS 引导下（MIPS 组），4 例在实质切除前仅使用常规 ICG 荧光技术（非 MIPS 组）。通过对捕获的荧光图像进行密度测定来评估每个横断平面的荧光面积比。通过从残肝侧减去切除侧的荧光面积率来计算准确的荧光面积比。
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=0.038）。
基于我们新方法的结果，使用 MIPS 的实时导航可能有助于沿肝段之间的平面进行 AR。
