Concomitant Use of Indocyanine Green Fluorescence Imaging and Interventional Radiology for Detection of Liver Segments During Laparoscopic Anatomical Liver Resection: Pilot Feasibility Study

Abstract

We investigate the feasibility of using indocyanine green (ICG) fluorescence imaging with interventional radiology (IVR) techniques for indication of liver segments during laparoscopic anatomical liver resection (LapAR). Ten patients with planned LapAR (segmentectomy V, VI, VII, or VIII) were enrolled. Both IVR and LapAR were performed in a hybrid operating room. Two dyes (indigo carmine and ICG) and embolic solutions were injected into the target liver segment. We compared imaging results during LapAR. ICG fluorescence imaging (ICGFI) provided clear visual contrast. Median contrast index value of ICGFI was 1.12, superior to that of indigo carmine (0.21; P=0.005). ICGFI was still visible during liver resection. Estimated liver resection volume and actual resected liver weight correlated significantly (R=0.906; P<0.01). ICGFI delivered by IVR provided clearer visual information than conventional indigo carmine dye, enabling precise performance of LapAR as planned (UMIN-CTR No. 000023952).