Application Of Indocyanine Green Fluorescence Combined With Three-dimensional Visualization Technology In Laparoscopic Hepatectomy

Background : Indocyanine green（ICG）fluorescence imaging technology has been increasingly used in laparoscopic hepatectomy in recent years,and its functions include detection of tumors and liver segment boundaries.However,its staining characteristics in special tumors and its effect compared with traditional laparoscopic anatomical liver resection still need to be further explored.Methods:（1）11 patients who underwent laparoscopic hepatic hemangioma resection with ICG fluorescence combined with three-dimensional visualization technology in our hospital from January 2020 to May 2021 were collected.Individualized surgical plans were drawn up for all patients based on the results of three-dimensional reconstruction before surgery.12.5 mg of ICG was injected through a peripheral vein 24-48 hours before surgery,and indocyanine green fluorescence was used to accurately guide laparoscopic liver hemangioma resection during surgery.（2）A retrospective study was conducted on patients who were pathologically diagnosed with hepatocellular carcinoma and successfully underwent laparoscopic anatomical liver resection between January 2019 and December 2021.The short-term efficacy before and after the propensity matching score（PSM）was compared between the two groups.Results:（1）The preoperative 3D reconstruction surgical plans for all patients were the same as the intraoperative findings.Of the 11 patients,10 patients showed a ring-shaped fluorescent band around the tumor in intraoperative fluorescence imaging.The ICG fluorescence-guided laparoscopic hemangioma resection was successfully performed.In1 patient,the tumor grew exogenously,and the imaging failed,and no obvious ring was found.fluorescent band.In 11 patients,the intraoperative blood loss was 100（50-600）ml,the hepatic hilar blocking time was 30（0-70）minutes,and the operation time was180（100-290）minutes.One patient received blood transfusion during the operation.The postoperative hospital stay was 5（3-9）days,the postoperative peak ALT was 231（67-933）U/L,AST was 259（51-783）U/L,and TBIL was 12.5（7.7-17.6）μmol/L,ALB was 37（33.2-40.1）g/L.Only 1 patient developed pleural effusion after operation,and the other patients had no obvious complications.Postoperative pathology showed that all 11 patients were cavernous hemangioma.（2）A total of 106 patients were included in this study,including 52 in the ICG group and 54 in the traditional group.Compared with the traditional group,the ICG group had less intraoperative blood loss（200（100-450）vs.250（150-500）ml）,lower intraoperative blood transfusion rate（23.1% vs.31.5%）,and portal obstruction.The patients had shorter interruption time（17.5（2.5-30.0）vs.19.0（0-39.0）min）,lower postoperative complication rate（15.4% vs.27.8%）,and shorter operation time（243（179-286）vs.274（205-366）min）,the postoperative hospital stay was significantly shorter（6（5-8）vs.8（7-10）d,P=0.001）.The patients in the ICG group after PSM were still slightly lower than the traditional group in terms of operation time,intraoperative bleeding,and intraoperative blood transfusion rate,and the postoperative hospital stay was significantly shorter than that of the traditional group.Conclusion: Laparoscopic liver hemangioma resection guided by ICG fluorescence combined with three-dimensional visualization technology has good safety and feasibility,and the operation is simple.In hepatocellular carcinoma surgery,compared with traditional laparoscopic anatomical hepatectomy,laparoscopic anatomical hepatectomy guided by ICG fluorescence combined with three-dimensional visualization technology has a good short-term curative effect and significantly shortens the postoperative hospital stay of patients,and has good clinical application prospects.