title: Liver tumor boundaries identified intraoperatively using real-time indocyanine green fluorescence imaging.
abstract: OBJECTIVE
  Clear delineation between tumors and normal tissues is ideal for real-time surgical navigation imaging. We investigated applying indocyanine green (ICG) fluorescence imaging navigation using an intraoperative administration method in liver resection.
  
  
  METHODS
  Fifty patients who underwent liver resection were divided into two groups based on clinical situation and operative purpose. In group I, sizes of superficial liver tumors were determined; tiny tumors were identified. In group II, the liver resection margin was determined; real-time navigation was performed. ICG was injected intravenously at the beginning of the operation; the liver surface was observed with a photodynamic eye (PDE).
  
  
  RESULTS
  Liver resection margins were determined using PDE. Fluorescence contrast between normal liver and tumor tissues was obvious in 32 of 35 patients. A boundary for half the liver or specific liver segments was determined in nine patients by examining the portal vein anatomy after ICG injection. Eight small tumors not observed preoperatively were detected; the smallest was 2 mm.
  
  
  CONCLUSIONS
  ICG fluorescence imaging navigation is a promising, simple, and safe tool for routine real-time intraoperative imaging during hepatic resection and clinical exploration in hepatocellular carcinoma, enabling high sensibility for identifying liver resection margins and detecting tiny superficial tumors.
authors.affiliation: Department of Hepatobiliary Surgery, First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China. zhangyanminzym@126.com.
authors.forename: Ya-Min
authors.initials: YM
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Surgery, First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Shi
authors.affiliation: Department of Hepatobiliary Surgery, First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
authors.forename: Jian-Cun
authors.initials: JC
authors.lastname: Hou
authors.affiliation: Department of Hepatobiliary Surgery, First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
authors.forename: Zi-Rong
authors.initials: ZR
authors.lastname: Liu
authors.affiliation: Department of Hepatobiliary Surgery, First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
authors.forename: Zi-Lin
authors.initials: ZL
authors.lastname: Cui
authors.affiliation: Department of Hepatobiliary Surgery, First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Hepatobiliary Surgery, First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
authors.forename: Di
authors.initials: D
authors.lastname: Wu
authors.affiliation: Department of Hepatobiliary Surgery, First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Department of Hepatobiliary Surgery, First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
authors.forename: Zhong-Yang
authors.initials: ZY
authors.lastname: Shen
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005456:Fluorescent Dyes / Q000008:administration & dosage / Q000493:pharmacokinetics; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage / Q000493:pharmacokinetics; D007430:Intraoperative Care; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging; D014018:Tissue Distribution
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green
keywords: Fluorescence imaging; Hepatectomy; Indocyanine green; Liver neoplasms