An initial report on the intraoperative use of indocyanine green fluorescence imaging in the surgical management of liver tumorss.
BACKGROUND
There has been a recent interest in the use of Indocyanine green (ICG) imaging. The aim of this study is to review our initial experience in liver surgery.


METHODS
ICG fluorescent imaging was used in 15 patients undergoing surgical treatment of their liver tumors between 2015 and 2016. ICG imaging was initially performed, followed by intraoperative ultrasound (IOUS). Findings on fluorescence were compared with preoperative cross-sectional imaging and IOUS.


RESULTS
Sixty-two lesions were identified, with 34 located superficially and 28 deeply in the liver. While 13 patients underwent surgery for malignant liver metastases, two patients had operations for benign liver diseases. Seven patients underwent open or robotic liver resections, five laparoscopic microwave liver ablation, and three diagnostic laparoscopy. ICG identified all of the superficial lesions. IOUS identified 98% of all lesions. The most benefit of ICG was in showing the margins of the superficial lesions in real-time and guiding surgical treatment, which was limited by IOUS.


CONCLUSIONS
This is the first North American study to evaluate the potential utility of ICG during liver surgery. Its major benefit seems to be in providing real-time feedback to the surgeon about the margins of superficial tumors for resection or ablation. J. Surg. Oncol. 2016;114:625-629. © 2016 Wiley Periodicals, Inc.
Department of General Surgery, Cleveland Clinic, Ohio.
Hideo
H
Takahashi
Department of Endocrine Surgery, Cleveland Clinic, Ohio.
Nisar
N
Zaidi
Department of General Surgery, Cleveland Clinic, Ohio. berbere@ccf.org.|Department of Endocrine Surgery, Cleveland Clinic, Ohio. berbere@ccf.org.
Eren
E
Berber
D055011:Ablation Techniques; D000328:Adult; D000368:Aged; D004396:Coloring Agents; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted
D004396:Coloring Agents; D007208:Indocyanine Green
Indocyanine green; fluorescent imaging; liver surgery