Determination of the Surgical Margin in Laparoscopic Liver Resections Using Infrared Indocyanine Green Fluorescence

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2018 Jun 20

PMID 29915961

Citations 30

Authors

Takeshi Aoki

Masahiko Murakami

Tomotake Koizumi

Kazuhiro Matsuda

Akira Fujimori

Tomokazu Kusano

Yuta Enami

Satoru Goto

Makoto Watanabe

Koji Otsuka

Affiliations

Soon will be listed here.

Abstract

Purpose: Laparoscopic liver resection is increasingly used to treat patients with hepatic tumor. However, during laparoscopic resection, information obtained by palpation using laparoscopic forceps or from intraoperative ultrasonography is extremely limited, which may pose a risk for positive surgical margins. This study aimed to investigate the feasibility and clinical application of near-infrared (NIR) fluorescence imaging to guide laparoscopic liver resection of a liver tumor and secure the surgical margins.

Methods: A preliminary study in 25 patients was conducted. NIR imaging was used intraoperatively during laparoscopic liver resection. The liver tumors were preoperatively labeled by intravenously injecting the patients with indocyanine green dye (0.5 mg/kg), an NIR fluorescence agent. During the surgical procedure, the PINPOINT Endoscopic Fluorescence Imaging System was used to assess the surgical margin by using real-time endoscopic high-definition visible and NIR fluorescence imaging.

Results: All tumors were identified and resected laparoscopically by using the PINPOINT system, and all resections successfully secured the surgical margin. The pathological findings of all tumors indicated negative margins, defined as R0.

Conclusions: This technique showed the potential to improve the intraoperative identification and demarcation of tumors. Its use could potentially reduce the number of positive resection margins.

Citing Articles

Real-Time Navigation in Liver Surgery Through Indocyanine Green Fluorescence: An Updated Analysis of Worldwide Protocols and Applications.

Avella P, Spiezia S, Rotondo M, Cappuccio M, Scacchi A, Inglese G Cancers (Basel). 2025; 17(5).

PMID: 40075718 PMC: 11898688. DOI: 10.3390/cancers17050872.

Indocyanine green dyed gauze-guided minimum invasive surgery for anatomical landmarks and preventing gauze remnants: a pilot study.

Tashiro Y, Aoki T, Yasunaga H, Ando S Langenbecks Arch Surg. 2025; 410(1):40.

PMID: 39812866 DOI: 10.1007/s00423-024-03592-6.

Efficacy and safety of indocyanine green-fluorescence imaging guided liver resection: a single-arm prospective cohort study.

Gon H, Omiya S, Komatsu S, Yamasaki N, Murakami S, Fukushima K Langenbecks Arch Surg. 2025; 410(1):34.

PMID: 39794665 PMC: 11723889. DOI: 10.1007/s00423-024-03602-7.

Cutting-edge insights: near-infrared imaging for surgical margin assessment in head and neck tumor resection: a systematic review and meta-analysis.

Li K, Yang J, Lian H, Tian Z, Li C, Gao N Quant Imaging Med Surg. 2024; 14(12):8167-8182.

PMID: 39698655 PMC: 11651944. DOI: 10.21037/qims-24-564.

Liver Resection for Hepatocellular Carcinoma: Recent Advances.

Gundavda K, Patkar S, Varty G, Shah N, Velmurugan K, Goel M J Clin Exp Hepatol. 2024; 15(1):102401.

PMID: 39286759 PMC: 11402310. DOI: 10.1016/j.jceh.2024.102401.

References

Jafari M, Wexner S, Martz J, McLemore E, Margolin D, Sherwinter D . Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg. 2014; 220(1):82-92.e1. DOI: 10.1016/j.jamcollsurg.2014.09.015. View

Hibi T, Cherqui D, Geller D, Itano O, Kitagawa Y, Wakabayashi G . Expanding indications and regional diversity in laparoscopic liver resection unveiled by the International Survey on Technical Aspects of Laparoscopic Liver Resection (INSTALL) study. Surg Endosc. 2015; 30(7):2975-83. DOI: 10.1007/s00464-015-4586-y. View

Cahill R, Anderson M, Wang L, Lindsey I, Cunningham C, Mortensen N . Near-infrared (NIR) laparoscopy for intraoperative lymphatic road-mapping and sentinel node identification during definitive surgical resection of early-stage colorectal neoplasia. Surg Endosc. 2011; 26(1):197-204. DOI: 10.1007/s00464-011-1854-3. View

Hamady Z, Lodge J, Welsh F, Toogood G, White A, John T . One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach. Ann Surg. 2013; 259(3):543-8. DOI: 10.1097/SLA.0b013e3182902b6e. View

Olson E, Jiang T, Aguilera T, Nguyen Q, Ellies L, Scadeng M . Activatable cell penetrating peptides linked to nanoparticles as dual probes for in vivo fluorescence and MR imaging of proteases. Proc Natl Acad Sci U S A. 2010; 107(9):4311-6. PMC: 2840175. DOI: 10.1073/pnas.0910283107. View

Figueras J, Burdio F, Ramos E, Torras J, Llado L, Lopez-Ben S . Effect of subcentimeter nonpositive resection margin on hepatic recurrence in patients undergoing hepatectomy for colorectal liver metastases. Evidences from 663 liver resections. Ann Oncol. 2007; 18(7):1190-5. DOI: 10.1093/annonc/mdm106. View

Kudo H, Ishizawa T, Tani K, Harada N, Ichida A, Shimizu A . Visualization of subcapsular hepatic malignancy by indocyanine-green fluorescence imaging during laparoscopic hepatectomy. Surg Endosc. 2014; 28(8):2504-8. DOI: 10.1007/s00464-014-3468-z. View

van der Poel H, Buckle T, Brouwer O, Olmos R, van Leeuwen F . Intraoperative laparoscopic fluorescence guidance to the sentinel lymph node in prostate cancer patients: clinical proof of concept of an integrated functional imaging approach using a multimodal tracer. Eur Urol. 2011; 60(4):826-33. DOI: 10.1016/j.eururo.2011.03.024. View

Kokudo N, Miki Y, Sugai S, Yanagisawa A, Kato Y, Sakamoto Y . Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg. 2002; 137(7):833-40. DOI: 10.1001/archsurg.137.7.833. View

10.

Troyan S, Kianzad V, Gibbs-Strauss S, Gioux S, Matsui A, Oketokoun R . The FLARE intraoperative near-infrared fluorescence imaging system: a first-in-human clinical trial in breast cancer sentinel lymph node mapping. Ann Surg Oncol. 2009; 16(10):2943-52. PMC: 2772055. DOI: 10.1245/s10434-009-0594-2. View

11.

Sosnovik D, Nahrendorf M, Deliolanis N, Novikov M, Aikawa E, Josephson L . Fluorescence tomography and magnetic resonance imaging of myocardial macrophage infiltration in infarcted myocardium in vivo. Circulation. 2007; 115(11):1384-91. DOI: 10.1161/CIRCULATIONAHA.106.663351. View

12.

Deguchi J, Aikawa M, Tung C, Aikawa E, Kim D, Ntziachristos V . Inflammation in atherosclerosis: visualizing matrix metalloproteinase action in macrophages in vivo. Circulation. 2006; 114(1):55-62. DOI: 10.1161/CIRCULATIONAHA.106.619056. View

13.

Muratore A, Ribero D, Zimmitti G, Mellano A, Langella S, Capussotti L . Resection margin and recurrence-free survival after liver resection of colorectal metastases. Ann Surg Oncol. 2009; 17(5):1324-9. DOI: 10.1245/s10434-009-0770-4. View

14.

Takahashi H, Zaidi N, Berber E . An initial report on the intraoperative use of indocyanine green fluorescence imaging in the surgical management of liver tumorss. J Surg Oncol. 2016; 114(5):625-629. DOI: 10.1002/jso.24363. View

15.

Uchiyama K, Ueno M, Ozawa S, Kiriyama S, Shigekawa Y, Yamaue H . Combined use of contrast-enhanced intraoperative ultrasonography and a fluorescence navigation system for identifying hepatic metastases. World J Surg. 2010; 34(12):2953-9. DOI: 10.1007/s00268-010-0764-1. View

16.

Yamauchi K, Nagafuji H, Nakamura T, Sato T, Kohno N . Feasibility of ICG fluorescence-guided sentinel node biopsy in animal models using the HyperEye Medical System. Ann Surg Oncol. 2011; 18(7):2042-7. DOI: 10.1245/s10434-010-1499-9. View

17.

Tanaka E, Choi H, Fujii H, Bawendi M, Frangioni J . Image-guided oncologic surgery using invisible light: completed pre-clinical development for sentinel lymph node mapping. Ann Surg Oncol. 2006; 13(12):1671-81. PMC: 2474791. DOI: 10.1245/s10434-006-9194-6. View

18.

Figueiredo J, Siegel C, Nahrendorf M, Weissleder R . Intraoperative near-infrared fluorescent cholangiography (NIRFC) in mouse models of bile duct injury. World J Surg. 2009; 34(2):336-43. PMC: 2809822. DOI: 10.1007/s00268-009-0332-8. View

19.

Vahrmeijer A, Hutteman M, van der Vorst J, van de Velde C, Frangioni J . Image-guided cancer surgery using near-infrared fluorescence. Nat Rev Clin Oncol. 2013; 10(9):507-18. PMC: 3755013. DOI: 10.1038/nrclinonc.2013.123. View

20.

Gotoh K, Yamada T, Ishikawa O, Takahashi H, Eguchi H, Yano M . A novel image-guided surgery of hepatocellular carcinoma by indocyanine green fluorescence imaging navigation. J Surg Oncol. 2009; 100(1):75-9. DOI: 10.1002/jso.21272. View