Department of General Surgery, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
IHU-Strasbourg, 560036Institute of Image-Guided Surgery, Strasbourg, France.
Surg Innov. 2021 Dec;28(6):669-678. doi: 10.1177/1553350621996972. Epub 2021 Mar 31.
Despite the increasing number of laparoscopic hepatic procedures for the resection of hepatocellular carcinoma (HCC), intraoperative tumor localization and demarcation remains challenging in comparison to open surgery. In this study, we evaluated the feasibility of positive liver segment staining through the super-selective intra-arterial indocyanine green (ICG) administration.
Eight patients presenting with a single HCC underwent an interventional vascular procedure followed by laparoscopic surgery. A microcatheter was advanced into the hepatic artery branches perfusing the HCC followed by digital subtraction angiography and angiography computed tomography (angio-CT). Patients were then transferred to the operating room, and a laparoscopic hepatectomy was performed under ultrasound guidance. A 5 mL bolus of ICG with a concentration of .125 mg/mL was injected through the microcatheter, and a near-infrared laparoscope was used to detect the fluorescence signal to assess the correspondence between the fluorescence-based demarcation and the intraoperative ultrasound-based demarcation.
The duration for the angiography procedure was 32.7 +/- 5.3 min, and it took 242 +/- 118 min from the end of angiography procedure until the start of the surgical procedure. In all cases, the fluorescent liver segment was corresponding to the angio-CT findings. In 6/8 cases, fluorescence imaging was considered helpful in the identification of the resection line. In 3 patients, the resection line was changed according to the positively stained liver segment.
We successfully demonstrated the feasibility of the super-selective intra-arterial ICG administration for fluorescence-based positive staining of hepatic segmentation during laparoscopic surgery for HCC (NCT04266548).
尽管腹腔镜肝切除术治疗肝细胞癌（HCC）的数量不断增加，但与开腹手术相比，术中肿瘤定位和标记仍然具有挑战性。在这项研究中，我们评估了通过超选择性肝内吲哚菁绿（ICG）给药进行阳性肝段染色的可行性。
8 名患有单发 HCC 的患者接受了介入血管程序，然后进行腹腔镜手术。将微导管推进到供应 HCC 的肝动脉分支中，然后进行数字减影血管造影和血管造影计算机断层扫描（angio-CT）。然后将患者转移到手术室，在超声引导下进行腹腔镜肝切除术。通过微导管注射 5 mL 浓度为.125 mg/mL 的 ICG 溶液，使用近红外腹腔镜检测荧光信号，以评估荧光标记与术中超声标记之间的对应关系。
血管造影程序的持续时间为 32.7 +/- 5.3 分钟，从血管造影程序结束到手术开始需要 242 +/- 118 分钟。在所有情况下，荧光肝段与 angio-CT 结果相符。在 6/8 例中，荧光成像被认为有助于识别切除线。在 3 名患者中，根据阳性染色肝段改变了切除线。
我们成功地证明了在腹腔镜 HCC 手术中通过超选择性肝内 ICG 给药进行荧光阳性肝段染色的可行性（NCT04266548）。
