Consensus Guidelines for the Use of Fluorescence Imaging in Hepatobiliary Surgery

Abstract

Objective: To establish consensus recommendations for the use of fluorescence imaging with indocyanine green (ICG) in hepatobiliary surgery. Background: ICG fluorescence imaging has gained popularity in hepatobiliary surgery in recent years. However, there is varied evidence on the use, dosage, and timing of administration of ICG in clinical practice. To standardize the use of this imaging modality in hepatobiliary surgery, a panel of pioneering experts from the Asia-Pacific region sought to establish a set of consensus recommendations by consolidating the available evidence and clinical experiences. Methods: A total of 13 surgeons experienced in hepatobiliary surgery and/or minimally invasive surgery formed an expert consensus panel in Shanghai, China in October 2018. By the modified Delphi method, they presented the relevant evidence, discussed clinical experiences, and derived consensus statements on the use of ICG in hepatobiliary surgery. Each statement was discussed and modified until a unanimous consensus was achieved. Results: A total of 7 recommendations for the clinical applications of ICG in hepatobiliary surgery were formulated. Conclusions: The Shanghai consensus recommendations offer practical tips and techniques to augment the safety and technical feasibility of ICG fluorescence-guided hepatobiliary surgery, including laparoscopic cholecystectomy, liver segmentectomy, and liver transplantation.

Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses

“…In LLR, the surgeons had lost his tactile sensation during surgery. The presence of ICG florescence helps to better identify the tumour margin with potential additional advantages of real time illumination of occult lesions and identifying important anatomical landmarks of the liver (30,39). Laparoscopy with high definition and angulation ability may also assist in better identifying lesions and performing resections at a more favorable angle potentially allowing more meticulous dissection of the superiorly located hepatic veins.…”

The Applications of 3D Imaging and Indocyanine Green Dye Fluorescence in Laparoscopic Liver Surgery

“…First and foremost, the biliary secretion of the dye allows to visualize the bile ducts during cholecystectomies, donor hepatectomies or liver resections with bile duct resections, allowing to precisely identify the structures that need to be saved or cut. In a recent consensus conference on the applications of ICG in hepatobiliary surgery, experts found that the use of this technology, significantly improved the accuracy of bile duct identification and reduced the incidence of iatrogenic injuries [ 36 ]. Furthermore, ICG can also be used to detect bile leaks from the cutting surface, although there are only preliminary reports on the usefulness of this technology in this setting [ 37 ].…”

Recent Advances in Photodynamic Imaging and Therapy in Hepatobiliary Malignancies: Clinical and Experimental Aspects

“…ICG photodynamic eye imaging equivalent to PDD allows segmental visualization of hepatic blood flow, which has been useful for anatomical liver resections [79,90,91,96]. In 2021, the first worldwide consensus guideline for the fluorescence imaging using ICG in hepatobiliary Surgery has been eventually published [97]. Cyanine dye also has photosensitizing characteristics [98].…”