Mehdorn Anne-Sophie, Richter Florian, Hess Katharina, Beckmann Jan Henrik, Egberts Jan-Hendrik, Linecker Michael, Becker Thomas, Braun Felix
Department of General, Abdominal, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
Department of Pathology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
J Clin Med. 2022 Jun 19;11(12):3527. doi: 10.3390/jcm11123527.
Introduction: Robotic-assisted liver surgery (RALS) with its known limitations is gaining more importance. The fluorescent dye, indocyanine green (ICG), is a way to overcome some of these limitations. It accumulates in or around hepatic masses. The integrated near-infrared cameras help to visualize this accumulation. We aimed to compare the influence of ICG staining on the surgical and oncological outcomes in patients undergoing RALS. Material and Methods: Patients who underwent RALS between 2014 and 2021 at the Department of General Surgery at the University Hospital Schleswig-Holstein, Campus Kiel, were included. In 2019, ICG-supported RALS was introduced. Results: Fifty-four patients were included, with twenty-eight patients (50.9%) receiving preoperative ICG. Hepatocellular carcinoma (32.1%) was the main entity resected, followed by the metastasis of colorectal cancers (17%) and focal nodular hyperplasia (15.1%). ICG staining worked for different tumor entities, but diffuse staining was noted in patients with liver cirrhosis. However, ICG-supported RALS lasted shorter (142.7 ± 61.8 min vs. 246.4 ± 98.6 min, p < 0.001), tumors resected in the ICG cohort were significantly smaller (27.1 ± 25.0 mm vs. 47.6 ± 35.2 mm, p = 0.021) and more R0 resections were achieved by ICG-supported RALS (96.3% vs. 80.8%, p = 0.075). Conclusions: ICG-supported RALS achieve surgically and oncologically safe results, while overcoming the limitations of RALS.
尽管存在已知局限性，但机器人辅助肝脏手术（RALS）正变得越来越重要。荧光染料吲哚菁绿（ICG）是克服其中一些局限性的一种方法。它会在肝肿块内或其周围积聚。集成的近红外摄像头有助于可视化这种积聚。我们旨在比较ICG染色对接受RALS患者的手术和肿瘤学结局的影响。
纳入2014年至2021年在基尔大学医院石勒苏益格-荷尔斯泰因校区普通外科接受RALS的患者。2019年引入了ICG辅助的RALS。
共纳入54例患者，其中28例（50.9%）接受了术前ICG。肝细胞癌（32.1%）是主要切除的实体瘤，其次是结直肠癌转移瘤（17%）和局灶性结节性增生（15.1%）。ICG染色对不同肿瘤实体均有效，但在肝硬化患者中观察到弥漫性染色。然而，ICG辅助的RALS持续时间更短（142.7±61.8分钟对246.4±98.6分钟，p<0.001），ICG组切除的肿瘤明显更小（27.1±25.0毫米对47.6±35.2毫米，p=0.021），ICG辅助的RALS实现了更多的R0切除（96.3%对80.8%，p=0.075）。
ICG辅助的RALS在手术和肿瘤学方面均取得了安全的结果，同时克服了RALS的局限性。
