title: Visualization of subcapsular hepatic malignancy by indocyanine-green fluorescence imaging during laparoscopic hepatectomy.
abstract: BACKGROUND
  Although laparoscopic hepatectomy has increasingly been used to treat cancers in the liver, the accuracy of intraoperative diagnosis may be inferior to that of open surgery because the ability to visualize and palpate the liver surface during laparoscopy is relatively limited. Fluorescence imaging has the potential to provide a simple compensatory diagnostic tool for identification of cancers in the liver during laparoscopic hepatectomy.
  
  
  METHODS
  In 17 patients who were to undergo laparoscopic hepatectomy, 0.5 mg/kg body weight of indocyanine green (ICG) was administered intravenously within the 2 weeks prior to surgery. Intraoperatively, a laparoscopic fluorescence imaging system obtained fluorescence images of its surfaces during mobilization of the liver.
  
  
  RESULTS
  In all, 16 hepatocellular carcinomas (HCCs) and 16 liver metastases (LMs) were resected. Of these, laparoscopic ICG fluorescence imaging identified 12 HCCs (75%) and 11 LMs (69%) on the liver surfaces distributed over Couinaud's segments 1-8, including the 17 tumors that had not been identified by visual inspections of normal color images. The 23 tumors that were identified by fluorescence imaging were located closer to the liver surfaces than another nine tumors that were not identified by fluorescence imaging (median [range] depth 1 [0-5] vs. 11 [8-30] mm; p < 0.001).
  
  
  CONCLUSIONS
  Like palpation during open hepatectomy, laparoscopic ICG fluorescence imaging enables real-time identification of subcapsular liver cancers, thus facilitating estimation of the required extent of hepatic mobilization and determination of the location of an appropriate hepatic transection line.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kudo
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ishizawa
authors.forename: Keigo
authors.initials: K
authors.lastname: Tani
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Harada
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ichida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shimizu
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.forename: Taku
authors.initials: T
authors.lastname: Aoki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green