Indocyanine Green Fluorescence Navigation in Liver Surgery

Abstract

Background:Indocyanine green (ICG) fluorescence has proven to be a high potential navigation tool during liver surgery; however, its optimal usage is still far from being standardized.Methods:A systematic review was conducted on MEDLINE/PubMed for English articles that contained the information of dose and timing of ICG administration until February 2021. Successful rates of tumor detection and liver segmentation, as well as tumor/patient background and imaging settings were also reviewed. The quality assessment of the articles was performed in accordance with the Scottish Intercollegiate Guidelines Network (SIGN).Results:Out of initial 311 articles, a total of 72 manuscripts were obtained. The quality assessment of the included studies revealed usually low; only 9 articles got qualified as high quality. Forty articles (55%) focused on open resections, whereas 32 articles (45%) on laparoscopic and robotic liver resections. Thirty-four articles (47%) described tumor detection ability, and 25 articles (35%) did liver segmentation ability, and the others (18%) did both abilities. Negative staining was reported (42%) more than positive staining (32%). For tumor detection, majority used the dose of 0.5 mg/kg within 14 days before the operation day, and an additional administration (0.02–0.5 mg/kg) in case of longer preoperative interval. Tumor detection rate was reported to be 87.4% (range, 43%–100%) with false positive rate reported to be 10.5% (range, 0%–31.3%). For negative staining method, the majority used 2.5 mg/body, ranging from 0.025 to 25 mg/body. For positive staining method, the majority used 0.25 mg/body, ranging from 0.025 to 12.5 mg/body. Successful segmentation rate was 88.0% (range, 53%–100%).Conclusion:The time point and dose of ICG administration strongly needs to be tailored case by case in daily practice, due to various tumor/patient backgrounds and imaging settings.

Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma

“…35 Although not routinely used in this study (31% of all RLRs), the use of ICG fluorescence is increasing for tumor identification and surface mapping because of its greater safety and effectiveness. 21,35,36 Instrumentation is another hotly debated topic, with a particular focus on the lack of CUSA among robotic tools. Hybrid techniques with the use of laparoscopic CUSA by the tableside surgeon have been described, claiming increasing safety and reduced morbidity.…”

“…Moreover, instrument articulation outperforms in vascular control and parenchymal dissection for posterior segments. The integrated 3-dimensional firefly detection with 2 levels of sensitivity may improve tumor identification and radical excision in the near future . Although not routinely used in this study (31% of all RLRs), the use of ICG fluorescence is increasing for tumor identification and surface mapping because of its greater safety and effectiveness …”

“…The integrated 3-dimensional firefly detection with 2 levels of sensitivity may improve tumor identification and radical excision in the near future . Although not routinely used in this study (31% of all RLRs), the use of ICG fluorescence is increasing for tumor identification and surface mapping because of its greater safety and effectiveness …”

Indocyanine Green Fluorescence Imaging as an Indispensable Tool for Modern Liver Surgery

“…A Delphi survey or a consensus meeting among experts may be the second-best way to guide clinical use, 19,20 but these determinations are not necessarily “optimal,” just the methods “most frequently used” at high-volume centers. Wakabayashi et al 16 did a through and comprehensive review, and they offered reasonable recommendations for liver cancer imaging: a dose of 0.5 mg/kg 14 days before the date of surgery that can also serve as a liver function test, and additional administration (0.02–0.5 mg/kg) in the event of a longer preoperative interval. For hepatic segmental staining, they recommended 2.5 mg/body (0.025–25 mg/body) for negative staining and 0.25 mg/body (0.025–12.5 mg/body) for positive staining.…”

“…These multiple uses are a major advantage of ICG, but they can also be a disadvantage because standardizing the optimal dose and determining the timing of ICG is difficult. Wakabayashi and colleagues conducted a systematic view to provide optimal clinical solutions to those very practical and important questions 16 …”