Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
Surg Endosc. 2024 Sep;38(9):5108-5113. doi: 10.1007/s00464-024-11010-7. Epub 2024 Jul 17.
Hepatic arterial infusion pump (HAIP) treatment is a technique used to treat liver localized malignancy with intra-arterial chemotherapy. Methylene blue is generally administered to verify hepatic perfusion and exclude inadvertent extrahepatic perfusion. The use of indocyanine green dye (ICG) combined with near-infrared (NIR) fluorescence imaging during robot-assisted HAIP placement may be an attractive alternative by providing high contrast without blue discoloration of the operative field.
Data was collected retrospectively from 2 centers in the Netherlands. Intraoperative perfusion of the liver segments and extrahepatic perfusion were assessed using ICG/NIR as well as methylene blue on video imaging and correlated to postoperative 99 m-Tc perfusion scintigraphy.
13 patients underwent robot-assisted surgery for HAIP placement; median length of stay was 4 days, complications occurred in 4 patients. Hepatic perfusion showed identical patterns when ICG was compared with methylene blue. In 1 patient, additional extrahepatic perfusion was found using ICG, leading to further vessel ligation. Intraoperative ICG perfusion was concordant with 99 m-Tc perfusion scintigraphy.
Liver and extrahepatic perfusion determined by ICG fluorescence imaging is concordant with blue dye perfusion and 99 m-Tc perfusion scintigraphy. Therefore, ICG fluorescence imaging is deemed a safe and reliable technique for perfusion testing during robot-assisted HAIP placement.
肝动脉灌注泵（HAIP）治疗是一种通过动脉内化疗治疗肝脏局部恶性肿瘤的技术。亚甲蓝通常用于验证肝灌注并排除意外的肝外灌注。在机器人辅助 HAIP 放置过程中使用吲哚菁绿染料（ICG）联合近红外（NIR）荧光成像可能是一种有吸引力的替代方法，因为它提供了高对比度，而不会使手术区域变色。
数据从荷兰的 2 个中心进行回顾性收集。使用 ICG/NIR 以及亚甲蓝对视频成像进行术中肝段灌注和肝外灌注评估，并与术后 99m-Tc 灌注闪烁扫描相关联。
13 名患者接受机器人辅助 HAIP 放置手术；中位住院时间为 4 天，4 名患者发生并发症。ICG 与亚甲蓝相比，肝灌注显示出相同的模式。在 1 名患者中，使用 ICG 发现了额外的肝外灌注，导致进一步的血管结扎。术中 ICG 灌注与 99m-Tc 灌注闪烁扫描一致。
ICG 荧光成像确定的肝和肝外灌注与蓝染灌注和 99m-Tc 灌注闪烁扫描一致。因此，ICG 荧光成像被认为是机器人辅助 HAIP 放置过程中灌注测试的一种安全可靠的技术。
