Real-Time Blood Flow Assessment Using ICG Fluorescence Imaging During Hepatobiliary and Pancreatic Surgery with Consideration of Vascular Reconstruction.

BACKGROUND/OBJECTIVES: Indocyanine green (ICG) fluorescence imaging is widely utilized for visualizing hepatic tumors, hepatic segmentation, and biliary anatomy, improving the safety and curability of cancer surgery. However, its application for perfusion assessment in hepatobiliary and pancreatic (HBP) surgery has been less explored.

METHODS

This study evaluated outcomes of patients undergoing HBP surgery with vascular reconstruction from April 2022 to August 2024. During surgery, ICG (1.25-5 mg/body) was administered intravenously to assess the need and quality of vascular reconstruction via fluorescence imaging.

RESULTS

Among 30 patients undergoing hepatectomies and/or pancreatectomies, ICG fluorescence imaging was used in 16 cases (53%) to evaluate organ and vascular perfusion. In two hepatectomy cases with consideration of reconstruction of the middle hepatic veins, sufficient fluorescence intensities in drainage areas led to the avoidance of middle hepatic vein reconstruction. In 14 cases requiring vascular reconstruction, fluorescence imaging visualized smooth blood flow through anastomotic sites in 11 cases, while insufficient signals were observed in 3 cases. Despite this, re-do anastomoses were not indicated because the fluorescence signals in the targeted organs were adequate. Postoperative contrast-enhanced computed tomography confirmed satisfactory blood perfusion in all cases.

CONCLUSIONS

Real-time blood flow assessment using ICG fluorescence imaging provides valuable information for intraoperative decision-making in HBP surgeries that require vascular reconstruction of major vessels, such as hepatic arteries, veins, and the portal system.