Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
South China Institute of National Engineering Research Center of Innovation and Application of Minimally Invasive Instruments, Guangzhou, China.
Ann Surg Oncol. 2024 Nov;31(12):7894-7895. doi: 10.1245/s10434-024-16040-y. Epub 2024 Aug 13.
The regions of the liver with cholestasis caused by biliary tumors or thrombosis can be distinctly identified using indocyanine green (ICG) fluorescence imaging. The authors' team reported the application of bile-duct obstructed area imaging (BOAI) to assist open hepatectomy for intrahepatic cholangiocarcinoma (ICC) combined with intrahepatic bile duct obstruction previously. This video is the first report of real-time BOAI-guided three-dimensional (3D) laparoscopic hepatectomy using a 3D-4K fluorescence imaging system.
A 65-year-old man was admitted to the authors' institution with clonorchiasis. Preoperative computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed an obstruction and diffuse dilation of the right hepatic duct. A 15-min retention of ICG (ICG R15) was performed 5 days before the operation, with a 3.3% result. Preoperative planning involved performing laparoscopic right hemi-hepatectomy with regional lymph node dissection assisted by visualization technology. During the procedure, significant fluorescence accumulation in the right liver was shown by fluorescence imaging. With the guidance of real-time BOAI (Fig. 1), the regions of biliary obstruction were precisely resected, and the middle hepatic vein (MHV) was passively and adequately exposed on the cutting plane. Fig. 1 Administration steps for real-time bile duct-obstructed area imaging. A ICG is injected intravenously 3-5 days before operation at a dose of 0.5 mg/kg. B ICG is accumulated in the whole liver within a few minutes after injection. C ICG is selectively absorbed by the liver and excreted into the intestines, whereby it is retained in areas of biliary obstruction RESULTS: The histopathologic diagnosis indicated high-grade intraepithelial neoplasia of the right bile duct tumor without lymph node metastases and clonorchiasis. The duration of the operation was 300 min, with an intraoperative blood loss of 50 ml. No postoperative complications occurred, and the patient was discharged after 7 days.
Laparoscopic right hemi-hepatectomy for the bile-duct obstructed area with the guidance of real-time BOAI is feasible and effective.
应用吲哚菁绿（ICG）荧光成像技术，可以明确显示出由胆管肿瘤或血栓引起的肝内胆汁淤积区域。作者团队此前曾报道过应用胆管阻塞区域成像（BOAI）辅助开腹肝切除术治疗肝内胆管癌（ICC）合并肝内胆管阻塞。本视频首次报道了使用三维（3D）-4K 荧光成像系统实时引导 BOAI 进行腹腔镜下肝切除术的情况。
一名 65 岁男性因华支睾吸虫病入院。术前计算机断层扫描（CT）和磁共振胰胆管成像（MRCP）显示右肝管阻塞和弥漫性扩张。手术前 5 天进行了 15 分钟 ICG（ICG R15）潴留试验，结果为 3.3%。术前计划包括应用可视化技术辅助腹腔镜右半肝切除术和区域淋巴结清扫术。术中荧光成像显示右肝有明显荧光聚集。在实时 BOAI 的指导下（图 1），精确切除了胆管阻塞区域，中肝静脉（MHV）在切割平面上被动且充分显露。图 1 实时胆管阻塞区域成像的给药步骤。A 在手术前 3-5 天，按 0.5mg/kg 的剂量静脉注射 ICG。B 注射后几分钟内，ICG 就会在整个肝脏内积聚。C ICG 被肝脏选择性吸收并排入肠道，从而在胆管阻塞区域被保留。
组织病理学诊断表明右胆管肿瘤高级别上皮内瘤变，无淋巴结转移和华支睾吸虫病。手术时间为 300 分钟，术中出血量为 50ml。术后无并发症发生，患者 7 天后出院。
实时 BOAI 引导腹腔镜右半肝切除术治疗胆管阻塞区域是可行且有效的。
