Laparoscopic indocyanine green fluorescence imaging combined with ultrasound-guided ablation for liver tumors / 中华肝胆外科杂志

ABSTRACT

Objective To study the combined use of indocyanine green (ICG) fluorescence imaging and intraoperative ultrasound in laparoscopic tumor ablation.Methods This retrospective study was conducted between May 2016 and December 2017 on 81 patients with primary liver carcinoma,metastatic liver cancer and hepatic hemangioma who underwent laparoscopic tumor ablation using fluorescence imaging combined with intraoperative ultrasound guidance at the Union Hospital,Tongji Medical College,Huazhong University of Science and Technology.Preoperative venous injection of ICG was used to result in detection of intraoperative positive staining.Results Of 36 patients with primary liver carcinoma,the intrabepatic lesions in 20 patients could not be detected under fluorescence imaging.The ablation was performed under intraoperative ultrasound guidance.However,for all the subcapsular lesions in 16 patients,including 15 patients with tumors with non-distinguishing boundaries under the bright-field model,the lesions were captured on fluorescence imaging.Of 18 patients with metastatic liver cancer with 54 lesions,all the intrahepatic and subcapsular lesions were not stained by ICG,but the subcapsular lesions could be distinguished by staining of the surrounding liver tissues.Of 27 patients with subcapsular hepatic hemangiomas,the lesions were not stained but they could be distinguished by staining of the peripheral liver tissues.All laparoscopic treatments for the 81 patients were performed successfully without conversion to laparotomy.The average ablation time for a single lesion was (8.5 ± 3.5) minutes.The intraoperative blood loss was 0～20 ml.Two patients developed intraoperative subcutaneous emphysema and 1 patient hemoglobinuria.There was no postoperative bleeding,postoperative renal insufficiency,bile leakage and significant collateral tissue damage.Conclusions Laparoscopic ultrasound guided tumor ablation resulted in low intra-and post-operative complications.The procedure was safe and effective.Ultrasound combined with fluorescence imaging clearly distinguished tumors from the adjacent normal tissues.This technique is clinically useful.