Application of ICG-Fluorescence Adjuvant to Laparoscopic Ultrasound in Minimally Invasive Liver Resection

Matteo Barabino, MD

Product Details
Product ID: ACS-6114
Year Produced: 2020
Length: 8 min.


AIMS: intraoperative indocyanine green fluorescence (ICG) has recently shown to represent a valid tool in minimally invasive liver surgery, thus joining better intraoperative staging and tumor detection, and providing a real-time guide during parenchymal resection. Aim of this video is to report our experience in routinely application of ICG during laparoscopic liver resection. METHODS: we analyzed 10 consecutive cases underwent laparoscopic liver resections for malignant tumors (6 HCC and 4 CRLM) at our HPB Surgical Unit. ICG was injected intravenously for a preoperative liver function test, and then the dye also served as the fluorescence source during operation for staging and identification of lesions and to define sharp transection line. RESULTS: Correct tumor staining was reported in all patients. Fourteen tumors were correctly visualized with ICG-fluorescence, while only 11 with LUS (100% vs 71%). The Achille's heel of LUS was identification of superficial lesions in cirrhotic patients with irregular surface. We found ICG useful in providing a real-time marker on the tumor edge leading an adequate transection line while going deeper, thus helping to obtain free margins resection. CONCLUSIONS: ICG-fluorescence, has proved to be an easy reproducible and effective technique adjuvant to LUS, either for staging or for sharp detection of superficial and tiny lesions in cirrhotic patients. Moreover, ICG can be an effective guide during liver transection especially for CRLM, in which anatomic resection is not recommended.