Coco Danilo, Leanza Silvana, Viola Massimo Giuseppe
Department of General, Robotic, Oncologic Surgery, Giglio Hospital Foundation, Cefalù, Italy.
Department of General, Robotic, Oncologic Surgery, G.Panico Hospital, Tricase, Lecce, Italy.
J Robot Surg. 2025 Sep 14;19(1):603. doi: 10.1007/s11701-025-02687-6.
The integration of indocyanine green (ICG) fluorescence imaging into robotic liver segmentectomies has improved intraoperative visualization for parenchymal-sparing hepatic resections. This systematic review and meta-analysis of 15 prospective and retrospective studies (n = 612 patients) found that ICG navigation was associated with higher rates of R0 resection, with a pooled odds ratio of 2.34 (95% CI 1.56-3.51, I = 32%) compared with conventional techniques. Quantitative analysis showed reductions in intraoperative blood loss (mean difference - 85 mL, 95% CI - 120 to - 50 mL) and bile leak incidence (3.1% vs 6.1%, p = 0.03), with no statistically significant difference in operative times (mean difference - 12 min, p = 0.12). Subgroup analyses indicated greater benefits for colorectal liver metastases (OR 3.12, 95% CI 1.89-5.15) and posterosuperior segment resections (margin improvement + 2.3 mm, p = 0.03). Efficacy was lower in cirrhotic livers (82.4% vs 97.1% success rate, p = 0.002), suggesting a need for tailored protocols in this group. Reported protocols varied by surgical aim: systemic 24-h preoperative injection was primarily used for tumor localization and margin visualization, while intraoperative portal vein injection was applied for segmental demarcation using positive or negative staining. These findings support ICG fluorescence as a useful adjunct in robotic liver segmentectomies, while underscoring the need to standardize dosing regimens and evaluate long-term survival outcomes.
将吲哚菁绿（ICG）荧光成像技术整合到机器人肝脏段切除术中，改善了保留实质的肝切除术的术中可视化效果。这项对15项前瞻性和回顾性研究（n = 612例患者）进行的系统评价和荟萃分析发现，与传统技术相比，ICG导航与更高的R0切除率相关，合并比值比为2.34（95%CI 1.56 - 3.51，I = 32%）。定量分析显示术中失血量减少（平均差异 - 85 mL，95%CI - 120至 - 50 mL）和胆漏发生率降低（3.1%对6.1%，p = 0.03），手术时间无统计学显著差异（平均差异 - 12分钟，p = 0.12）。亚组分析表明，对结直肠癌肝转移（OR 3.12，9%CI 1.89 - 5.15）和后上段切除术（切缘改善 + 2.3 mm，p = 0.03）有更大益处。在肝硬化肝脏中疗效较低（成功率82.4%对97.1%，p = 0.002），表明该组需要制定量身定制的方案。报告的方案因手术目的而异：术前24小时全身注射主要用于肿瘤定位和切缘可视化，而术中门静脉注射则用于通过阳性或阴性染色进行节段划分。这些发现支持ICG荧光作为机器人肝脏段切除术中的一种有用辅助手段，同时强调需要规范给药方案并评估长期生存结果。
