Abstract
Background: Indocyanine green fluorescence image has been used in hepatobiliary surgery, which was mainly started by Japanese surgeons to visualize hepatobiliary structures probably because it is regarded as a reagent for estimation of hepatic function.
Objectives: The objective of this study is to see the feasibility of use of indocyanine green in our setting during hepatobiliary surgery and its potential applications in the surgical treatment of benign and malignant liver pathology along with its selective use during difficult cholecystectomy to visualize extrahepatic biliary radical.
Methodology: This is a prospective cross sectional observational study performed including all consecutive patients who were posted for liver resection, both benign or malignant and selectively used in biliary surgery when biliary anatomy was uncertain.
Results: A total of thirty-nine patients had usage of indocyanine green, with a mean age of 51.6 ± 11.6 years (range, 31-75 years). In all our patients we were able to visualize the biliary system and liver parenchymal lesion.In the selective use of indocyanine green during difficult biliary anatomy during laparoscopic cholecystectomy 15/400 (3.75%), we were able to delineate biliary tree and hence five patients (1.2%) had to be converted to open cholecystectomy further preventing injury to the bile duct.
Conclusion: Indocyanine green fluorescence imaging can be used safely and easily to identify liver tumors, hepatic segments, and extrahepatic bile ducts in real time during open and minimally invasive surgery. This allows surgeons to map the anatomical variations, status of resection margin and prevent surgical complications.
References
Kubota K, Kita J, Shimoda M, et al. Intraoperative assessment of reconstructed vessels in living-donor liver transplantation, using a novel fluorescence imaging technique. J Hepatobiliary Pancreat Surg. 2006;13:100-4. [DOI]
Mitsuhashi N, Kimura F, Shimizu H, et al. Usefulness of intraoperative fluorescence imaging to evaluate local anatomy in hepatobiliary surgery. J Hepatobiliary Pancreat Surg. 2008;15:508-14. [DOI]
Ishizawa T, Tamura S, Masuda K, et al. Intraoperative fluorescent cholangiography using indocyanine green: a biliary road map for safe surgery. J Am CollSurg. 2009; 208:e1-4. [DOI]
Ishizawa T, Bandai Y, Kokudo N. Fluorescent cholangiography using indocyanine green for laparoscopic cholecystectomy: an initial experience. Arch Surg. 2009; 144:381-2. [DOI]
Ishizawa T, Fukushima N, Shibahara J, et al. Real-time identification of liver cancers by using indocyanine green fluorescent imaging. Cancer. 2009; 115:2491- 504. [DOI]
Ishizawa T, Masuda K, Urano Y, et al. Mechanistic background and clinical applications of indocyanine green fluorescence imaging of hepatocellular carcinoma. Ann SurgOncol. 2014; 21:440-8. [DOI]
Gurfinkel M, Thompson AB, Ralston W. Pharmacokinetics of ICG and HPPH-car for the detection of normal and tumor tissue using fluorescence, near-infrared reflectance imaging: a case study. PhotochemPhotobiol. 2000;72:94-102. [DOI]
Sakka SG. Assessing liver function. CurrOpinCrit Care. 2007;13:207-24. [DOI]
Landsman ML, Kwant G, Mook GA, Zijlstra WG. Light-absorbing properties, stability, and spectral stabilization of indocyanine green. J Appl Physiol. 1976; 40:575-83. [DOI]
Abo T, Nanashima A, Tobinaga S. Usefulness of intraoperative diagnosis of hepatic tumors located at the liver surface and hepatic segmental visualization using indocyanine green-photodynamic eye imaging. Eur J SurgOncol. 2015; 41:257-64. [DOI]
Polom K, Murawa D, Rho YS, Nowaczyk P, Hünerbein M, Murawa P. Current trends and emerging future ofindocyanine green usage in surgery and oncology: a literature review. Cancer. 2011; 117:4812-22. [DOI]
Bekheit M, Vibert E. Fluorescent-guided liver surgery: Paul Brousse experiences and perspective. In: Dip, FD, Ishizawa, T, Kokudo, N, Rosenthal, R, eds. Fluorescence Imaging for Surgeons: Concepts and Applications. Cham, Switzerland: Springer International; 2015:117-26. [DOI]
Shimada S, Ohtsubo S, Ogasawara K, Kusano M. Macro- and microscopic findings of ICG fluorescence in liver tumors. World J SurgOncol. 2015;13:198. [DOI]
Barabino G, Porcheron J, Cottier M. Improving surgical resection of metastatic liver tumors with near-infrared optical-guide fluorescence imaging. SurgInnov. 2016;23:354-9. [DOI]
Kudo H, Ishizawa T, Tani K. Visualization of subcapsular hepatic malignancy by indocyanine green fluorescence imaging during laparoscopic hepatectomy. SurgEndosc. 2014; 28:2504-8. [DOI]
Yamamichi T, Oue T, Yonekura T. Clinical application of indocyanine green (ICG) fluorescent imaging of hepatoblastoma. J Pediatr Surg. 2015;50:833-6. [DOI]
Chu W, Chennamsetty A, Toroussian R, Lau C. Anaphylactic Shock After Intravenous Administration of Indocyanine Green During Robotic Partial Nephrectomy. Urol Case Rep. 2017; 12:37-38. [DOI]
BjerregaardJ,Pandia MP, Jaffe RA. Occurrence of severe hypotension after indocyanine green injection during the intraoperative period. A Case Rep. 2013; 1:26-30. [DOI]
SPSS 16.0 statistical software (SPSS Inc Chicago, IL)
Björnsson OG, Murphy R, Chadwick VS. Physicochemical studies of indocyanine green (ICG): absorbance/concentration relationship, pH tolerance and assay precision in various solvents.Experientia, 1982;38(12),1441-2. [DOI]
Guyer DR, Puliafito CA, Monés JM, Friedman E, Chang W, Verdooner SR. Digital indocyaninegreen angiography in chorioretinal disorders. Ophthalmology. 1992; 99(2):287-91. [DOI]
Doss VT, Goyal N, Humphries W, Hoit D, Arthur A, Elijovich L. Comparison of Intraoperative Indocyanine Green Angiography and Digital Subtraction Angiography for Clipping of Intracranial Aneurysms. Interv Neurol. 2015; 3(3-4):129-34. [DOI]
Van der Pas MH, Ankersmit M, Stockmann HB, et al. Laparoscopic sentinel lymph node identification in patients with colon carcinoma using a nearinfrared dye: description of a 430 new technique and feasibility study. J Laparoendosc Adv Surg Tech A. 2013; 23:367-71. [DOI]
LeevyCM, Mendenhall CL, Lesko W, Howard MM. Estimation of hepatic blood flow with indocyanine green. J Clin Invest. 1962; 41(5):1169-79. [DOI]
El-Desoky A, Seifalian AM, Cope M, Delpy DT, Davidson BR. Experimental study of liver dysfunction evaluated by direct indocyanine green clearance using near infrared spectroscopy. Br J Surg. 1999; 86(8):1005-11. [DOI]
Jiao LR, El-Desoky AA, Seifalian AM, Habib N, Davidson BR. Effect of liver blood flow and function on hepatic indocyanine green clearance measured directly in a cirrhotic animal model. Br J Surg. 2000; 87(5):568-74. [DOI]
Hashimoto T, Miki K, Imamura H, et al. Sinusoidal perfusion in the veno-occlusive region of living liver donors evaluated by indocyanine green and nearinfrared spectroscopy. Liver Transpl. 2008; 14(6):872- 80. [DOI]
Kimura K, Otsuka Y, Katagiri T, Kubota Y, Ishii J, Maeda T , Tsuchiya M, Nozaki T, Kaneko H . Six Cases of Laparoscopic Hepatic Cyst Deroofing Aided by Indocyanine Green Fluorescence Imaging. The Japanese J Gastroenterol Surg. 2019 52. 76-82. [DOI]
Baiocchi GL, Diana M, Boni L. Indocyanine greenbased fluorescence imaging in visceral and hepatobiliary and pancreatic surgery: State of the art and future directions. World J Gastroenterol. 2018; 24(27):2921-30. [DOI]
Ankersmit M, van Dam DA, van Rijswijk AS, van den Heuvel B, Tuynman JB, Meijerink WJHJ. Fluorescent Imaging With Indocyanine Green During Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury. Surg Innov. 2017; 24(3):245-52. [DOI]
Ambe PC, Plambeck J, Fernandez-Jesberg V, Zarras K. The role of indocyanine green fluoroscopy for intraoperative bile duct visualization during laparoscopic cholecystectomy: an observational cohort study in 70 patients. Patient Saf Surg. 2019;13:2. [DOI]
Aoki T, Yasuda D, Shimizu Y, et al. Image-guided liver mapping using fluorescence navigation system with indocyanine green for anatomical hepatic resection. World J Surg. 2008; 32:1763-7. [DOI]
Gotoh K, Yamada T, Ishikawa O, et al. A novel image-guided surgery of hepatocellular carcinoma by indocyanine green fluorescence imaging navigation. J SurgOncol. 2009; 100:75-9. [DOI]
Rossi G, Tarasconi A, Baiocchi G, et al. Fluorescence guided surgery in liver tumors: applications and advantages. Acta Biomed. 2018;89(9-S):135-40. [DOI]
Ishizawa T, Zuker NB, Kokudo N, et al. Positive and negative staining of hepatic segments by use of fluorescent imaging techniques during laparoscopic hepatectomy. Arch Surg. 2012; 147:393- 4. [DOI]
Uchiyama K, Ueno M, Ozawa S, et al. Combined use of contrast-enhanced intraoperative ultrasonography and a fluorescence navigation system for identifying hepatic metastases. World J Surg. 2010; 34:2953-9. [DOI]
Kaibori M, Ishizaki M, Matsui K, Kwon AH. Intraoperative indocyanine green fluorescent imaging for prevention of bile leakage after hepatic resection. Surgery. 2011; 150:91-8. [DOI]