Clinical Significance of Real-Time Guidance Using the ICG Fluorescent Rim on the Resection Plane During Liver Parenchymal Transection.

Abstract

Determining tumor location during laparoscopic hepatectomy is challenging due to the lack of direct liver palpation and limitations of intraoperative ultrasound. Advances in indocyanine green (ICG) fluorescence imaging have significantly enhanced real-time visualization during hepatectomy, aiding in tumor detection and guiding resection margins. The present study assessed the clinical relevance of the detection by real-time ICG imaging of a fluorescent rim on the cut surface of the liver in determining resection margins in patients undergoing laparoscopic hepatectomy for malignant liver tumors. The present study evaluated patients who underwent laparoscopic hepatectomy using ICG fluorescence imaging from April 2020 to April 2023. If a fluorescent rim was detected on the cut surface of the liver during parenchymal transection, adjustments were made to the resection plane to ensure proper tumor clearance. The surgical transection plane was guided by real-time ICG fluorescence imaging, ensuring precise resection margins. Of the 300 patients who underwent laparoscopic hepatectomy using ICG fluorescence imaging, 20 were positive for an ICG fluorescent rim on the cut surface of the liver during parenchymal transection. The median tumor size was 26 mm (range: 4-52 mm), and the median resection margin was 4.5 mm (range: 0.8-10 mm). The median postoperative hospital stay was 6 days (range: 5-21 days). This study confirmed the preliminary safety of ICG fluorescence imaging in guiding resection margins during laparoscopic liver resection and provides technical insights into parenchymal preservation.