Tao Haisu, Wang Zhuangxiong, Zeng Xiaojun, Hu Haoyu, Li Jiang, Lin Jinyu, Lin Wenjun, Fang Chihua, Yang Jian
Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China.
Ann Surg Oncol. 2023 Nov;30(12):7373-7383. doi: 10.1245/s10434-023-14126-7. Epub 2023 Aug 22.
Laparoscopic anatomical Segment 8 (S8) resection is a highly challenging hepatectomy. Augmented reality navigation (ARN), which could be combined with indocyanine green (ICG) fluorescence imaging, has been applied in various complex liver resections and may also be applied in laparoscopic anatomical S8 resection. However, no study has explored how to apply ARN plus ICG fluorescence imaging (ARN-FI) in laparoscopic anatomical S8 resection, or explored its accuracy.
This study is a post hoc analysis that included 31 patients undergoing laparoscopic anatomical S8 resection from the clinical NaLLRFI trial, and the resected liver volume was measured in each patient. The perioperative parameters of safety and feasibility, as well as the accuracy analysis outcomes were compared.
There were 16 patients in the ARN-FI group and 15 patients underwent conventional laparoscopic hepatectomy without ARN or fluorescence imaging (non-ARN-FI group). There was no significant difference in baseline characteristics between the two groups. Compared with the non-ARN-FI group, the ARN-FI group had lower intraoperative bleeding (median 125 vs. 300 mL, P = 0.003). No significant difference was observed in other postoperative short-term outcomes. Accuracy analysis indicated that the actual resected liver volume (ARLV) in the ARN-FI group was more accurate.
ARN-FI was associated with less intraoperative bleeding and more accurate resection volume. These techniques may address existing challenges and provide rational guidance for laparoscopic anatomical S8 resection.
腹腔镜下解剖性肝段8（S8）切除术是一项极具挑战性的肝切除术。可与吲哚菁绿（ICG）荧光成像相结合的增强现实导航（ARN）已应用于各种复杂的肝切除术，也可能应用于腹腔镜下解剖性S8切除术。然而，尚无研究探讨如何在腹腔镜下解剖性S8切除术中应用ARN加ICG荧光成像（ARN-FI），或探讨其准确性。
本研究是一项事后分析，纳入了临床NaLLRFI试验中31例行腹腔镜下解剖性S8切除术的患者，并测量了每位患者切除的肝体积。比较了围手术期安全性和可行性参数以及准确性分析结果。
ARN-FI组有16例患者，15例患者接受了无ARN或荧光成像的传统腹腔镜肝切除术（非ARN-FI组）。两组患者的基线特征无显著差异。与非ARN-FI组相比，ARN-FI组术中出血量更低（中位数125 vs. 300 mL，P = 0.003）。其他术后短期结果未观察到显著差异。准确性分析表明，ARN-FI组实际切除的肝体积（ARLV）更准确。
ARN-FI与术中出血量减少和切除体积更准确相关。这些技术可能解决现有挑战，并为腹腔镜下解剖性S8切除术提供合理指导。
