Kanda Shuhei, Nishino Hiroto, Nishio Takahiro, Awidah Tariq, Chikamori Kentaro, Yoh Tomoaki, Kageyama Shoichi, Ogiso Satoshi, Anazawa Takayuki, Ishii Takamichi, Hatano Etsuro
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Ann Surg Oncol. 2025 Apr;32(4):2479-2480. doi: 10.1245/s10434-024-16736-1. Epub 2024 Dec 26.
Techniques involving dye injection or regional ischemia are commonly used for the precise identification of liver regions during hepatectomy. The visualization of regions with indocyanine green (ICG) has been widely used for liver segmentation. ICG is typically administered only once during each hepatectomy. We developed a threshold-adjustable Medical Imaging Projection System (MIPS) that projects ICG fluorescent images directly onto a patient's organ, which shows potential for real-time navigation. We report a case in which a fluorescence intensity gradient using two different doses of ICG was effective during anatomical right anterior sectionectomy.
A 73-year-old man underwent one radiation treatment and three radiofrequency ablations for hepatocellular carcinoma over the past 4 years. A follow-up computed tomography scan revealed a low-density lesion in segment 8 with a portal vein tumor thrombus (PVTT), and we planned a right anterior sectionectomy. A direct approach to the pedicle with the PVTT was not recommended as portal patency in the anterior section was unknown; therefore, we identified the three liver regions using a fluorescence intensity gradient.
The ICG fluorescence intensity gradient was established using two doses of ICG, which effectively identified the right posterior and anterior sections and the left lobe. MIPS clearly projected each section boundary onto the liver surface. Right anterior sectionectomy was successfully performed with no postoperative complications. Pathological examination revealed a negative surgical margin.
Utilizing multiple ICG dosages for boundary identification of liver regions has potential use for anatomic hepatectomy.
在肝切除术中，涉及染料注射或局部缺血的技术常用于精确识别肝区。吲哚菁绿（ICG）可视化已广泛用于肝脏分割。在每次肝切除术中，ICG通常仅给药一次。我们开发了一种阈值可调的医学影像投影系统（MIPS），可将ICG荧光图像直接投射到患者器官上，显示出实时导航的潜力。我们报告了一例在解剖性右前叶肝切除术中使用两种不同剂量ICG的荧光强度梯度有效的病例。
一名73岁男性在过去4年中接受了一次放射治疗和三次肝细胞癌射频消融治疗。随访计算机断层扫描显示肝段8有一个低密度病变，并伴有门静脉癌栓（PVTT），我们计划进行右前叶肝切除术。由于未知前叶门静脉的通畅情况，不建议直接处理带有PVTT的肝蒂；因此，我们使用荧光强度梯度识别了三个肝区。
使用两种剂量的ICG建立了ICG荧光强度梯度，有效识别了右后叶和前叶以及左叶。MIPS清晰地将每个肝段边界投射到肝脏表面。成功实施了右前叶肝切除术，术后无并发症。病理检查显示手术切缘阴性。
利用多种ICG剂量进行肝区边界识别在解剖性肝切除术中具有潜在应用价值。
