Image-guided liver mapping using fluorescence navigation system with indocyanine green for anatomical hepatic resection.
BACKGROUND
In malignant hepatic neoplasm, anatomic resection could improve survival and limit complications from hepatectomy. Our purpose was to develop an intraoperative method for identifying segment and subsegment of the liver with high-sensitivity near-infrared fluorescence imaging.


METHODS
The subjects were 35 patients with hepatic malignant liver disease who received hepatectomy in 2006. The segments of liver method of identification that used infrared observation camera system termed Photo Dynamic Eye-2 (PDE-2) with indocianine green (ICG) for the patient with malignant liver tumor (hepatocellular carcinoma: 13 cases; metastatic liver cancer: 18 cases; intrahepatic cholangio carcinoma: 4 cases) were performed before liver resection.


RESULTS
Although greenish stain of the liver surface after the injection of ICG via portal vein is not visible clearly without infrared observation camera system PDE-2, 1 minute after injection of ICG with fluorescent using infrared observation camera system PDE-2, demarcation of liver segment and subsegment was clearly detected. Ten minutes after injection of ICG with fluorescent using infrared observation camera system PDE-2, fluorescence of liver subsegment remained. Stained subsegment and segment of liver were identifiable in 33 (94.3%) of the 35 patients. There were no complications or side-effects related to the injection of patent blue dye.


CONCLUSIONS
We demonstrated here that near-infrared fluorescence imaging system is a novel and reliable intraoperative technique to identify hepatic segment and subsegment for anatomical hepatic resection.
Department of General and Gastroenterological Surgery, School of Medicine, Showa University, Tokyo, Japan. takejp@wb4.so-net.ne.jp
Takeshi
T
Aoki
Daisuke
D
Yasuda
Yoshinori
Y
Shimizu
Masanori
M
Odaira
Takashi
T
Niiya
Tomokazu
T
Kusano
Keitaro
K
Mitamura
Ken
K
Hayashi
Noriyuki
N
Murai
Tomotake
T
Koizumi
Hirohisa
H
Kato
Yuta
Y
Enami
Mitsuharu
M
Miwa
Mitsuo
M
Kusano
D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005456:Fluorescent Dyes; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green; D007259:Infrared Rays; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged
D005456:Fluorescent Dyes; D007208:Indocyanine Green