Application Of Indocyanine Green Fluorescence Imaging In Laparoscopic Hepatectomy

ObjectiveWith the development of laparoscopic technology,laparoscopic liver resection has been widely used in the treatment of Liver lesions.In the new era of safe,minimally invasive and precise resection of liver tumor,indocyanine green(ICG)molecular fluorescence imaging technology has become a hot spot in the field of hepatobiliary surgery.The purpose of this study is to explore the application experience and value of ICG molecular fluorescence imaging technology in laparoscopic hepatectomy,and to focus on the safety and effectiveness of ICG molecular fluorescence imaging technology in the treatment of hepatocellular carcinoma.MethodsFrom August 2017 to July 2019,112 cases of laparoscopic hepatectomy were performed under the guidance of ICG molecular fluorescence technology.According to the following three schemes(scheme I:1 day before operation,0.1mg/kg;scheme II:1 day before operation,0.25mg/kg;scheme III:3 days before operation,0.25mg/kg);laparoscopic hepatectomy was performed under the guidance of intraoperative fluorescence navigation.In the case of anatomic hepatectomy,the liver segment was stained by positive staining or negative staining,and the boundary of the liver segment and the scope of hepatectomy were determined according to the distribution of fluorescence signals.Then we compard the different staining methods to discuss usage and experience of ICG.In addition,69 patients in FLLR group and 229 patients in LLR group were collected at the same time,and the surgical conditions and postoperative complications were compared with those in LLR group and FLLR group.The DFS and OS of the two groups were analyzed by log-rank test.ResultsAmong 92 cases of laparoscopic hepatectomy guided by tumor staining,33 patients(94.8%)of scheme 3 was succeeded,and only 17 patients(58.6%)of scheme 2 was was succeeded.In addition,among all the 18 cases of failure,17 cases were accompanied by cirrhosis.In 20 cases of laparoscopic anatomical hepatectomy guided by ICG,2 cases failed to be stained.One case was due to lack of three-dimensional reconstruction before operation,and missed diagnosis of tumor thrombus in left portal vein,leading to the failure of positive staining during the operation;the other case was still due to lack of three-dimensional reconstruction before the operation,and the failure of founding and ligating S4 variant blood vessel.After the right liver was stained successfully,S4 segment and even the whole left liver were stained gradually.After 1:1 matching,65 patients in both groups were included in the analysis.Before and after matching,the operation time of FLLR group was shorter than that of LLR group(P<0.05);there was no significant difference in intraoperative bleeding,intraoperative blood transfusion,postoperative complications,DFS and OS between the two groups.ConelusionsLower than the normal injection dose and longer injection time can achieve better tumor staining effect,and the combination of preoperative 3D visualization and ICG molecular fluorescence imaging technology can achieve better liver segment staining effect.Compared with conventional laparoscopic hepatectomy,ICG fluorescence imaging molecular navigation technology is equally safe in laparoscopic hepatectomy,and has great advantages in shortening the operation time,and has the same long-term effect on tumor as conventional laparoscopic hepatectomy.