Franz Mareike, Arend Jörg, Bollensdorf Antonia, Lorenz Eric, Rahimli Mirhasan, Stelter Frederike, Petersen Manuela, Gumbs Andrew A, Croner Roland
Department of General, Visceral, Vascular and Transplant Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany.
Hôpital Antoine Béclère, Assistance Publique- Hôpitaux de Paris Béclère, 92140, Clamart, France.
Langenbecks Arch Surg. 2025 Apr 23;410(1):143. doi: 10.1007/s00423-025-03712-w.
Minimally invasive hepatobiliary surgery is performed increasingly either with robotic assistance or conventional laparoscopy. The lack of haptic feedback is one of the main challenges which has to be addressed during these procedures. Especially in oncological minimally invasive liver surgery Indocyanine green (ICG) can help to gain additional information for improved oncological quality.
Patients who underwent minimally invasive liver surgery for liver tumors between 01/2019 and 09/2022 and matched the study criteria were selected from the Magdeburg Registry of Minimally invasive liver surgery (MD-MILS). Patient demographics, tumor characteristics and perioperative data were analyzed retrospectively. The benefit of ICG for tumor identification and the resection procedure was assessed as 'very helpful', 'helpful' and 'not helpful' depending on the surgeon´s estimation.
Seventy-two patients who met the selection criteria were included in the analysis. Of these, 49 patients received ICG for intraoperative tumor visualization (ICG). Twenty-three patients with comparable demographics did not receive ICG and served as comparison group (nICG). A total of 69.4% robotic and 30.6% laparoscopic procedures were performed. In the ICG group procedural adjustments were significantly more frequent intraoperatively (p = 0.023). Intraoperative frozen section analysis on additional biopsies of ICG positive lesions were performed in 37% in the ICG group. In the nICG group suspect lesions, identified by ultrasound, went to frozen section in 17% (p = 0.006). Histopathological tumor positivity was identified in 12.2% in the ICG cohort vs no tumor positivity in the nICG cohort. This was one factor which led to the termination of surgery in 8% in the ICG vs the nICG 4.3% group (p = 0.485). In 88% intraoperative ICG visualization was scored as "helpful" when injected on preoperative day 4-7 with respect to the liver parenchyma structure and hepatocellular function.
ICG can improve oncological quality in minimally invasive liver resections. It provides additional visual information which can help to compensate the loss of haptics and tumor identification during liver tissue palpation. The intraoperative use of ICG was associated with no adverse events and did not prolong operative time. We recommend its routine use during minimally invasive liver surgery.
微创肝胆手术越来越多地通过机器人辅助或传统腹腔镜进行。缺乏触觉反馈是这些手术过程中必须解决的主要挑战之一。特别是在肿瘤微创肝脏手术中，吲哚菁绿（ICG）有助于获取更多信息以提高肿瘤学质量。
从马格德堡微创肝脏手术登记处（MD-MILS）中选取2019年1月至2022年9月期间因肝肿瘤接受微创肝脏手术且符合研究标准的患者。对患者的人口统计学、肿瘤特征和围手术期数据进行回顾性分析。根据外科医生的评估，将ICG对肿瘤识别和切除过程的益处评估为“非常有帮助”、“有帮助”和“无帮助”。
72名符合选择标准的患者纳入分析。其中，49名患者接受ICG用于术中肿瘤可视化（ICG组）。23名人口统计学特征相似的患者未接受ICG，作为对照组（非ICG组）。总共进行了69.4%的机器人手术和30.6%的腹腔镜手术。在ICG组，术中进行手术调整的频率明显更高（p = 0.023）。ICG组37%的患者对ICG阳性病变的额外活检进行了术中冰冻切片分析。在非ICG组，超声识别出的可疑病变进行冰冻切片分析的比例为17%（p = 0.006）。ICG队列中组织病理学肿瘤阳性率为12.2%，而非ICG队列中无肿瘤阳性。这是导致ICG组8%的手术终止的一个因素，而非ICG组为4.3%（p = 0.485）。当在术前第4 - 7天注射时，88%的术中ICG可视化在肝实质结构和肝细胞功能方面被评为“有帮助”。
ICG可提高微创肝切除的肿瘤学质量。它提供了额外的视觉信息，有助于弥补肝脏组织触诊过程中触觉和肿瘤识别的损失。术中使用ICG未出现不良事件，也未延长手术时间。我们建议在微创肝脏手术中常规使用ICG。
