Purpose

Indocyanine Green (ICG)-fluorescence imaging in hepatobiliary surgery field is widely used for visualization of extrahepatic bile duct anatomy, liver tumor detection and anatomic liver resection. In this study, we investigated feasibility and usefulness of ICG florescent imaging guided anatomic liver resection including robotic living donor hepatectomy.

Methods

From January 2016 to July 2018, 46 patient underwent anatomic liver resection using ICG florescent imaging system (Firefly®) in Da Vinci Robot. ICG (5 mg/2ml) was administrated though direct (via portal vein after clamping by individual ligation of extrahepatic Glisson approach) or indirect method (via peripheral vein) during operation before about 5-10 minutes that confirm the anatomic segmentation or right/left liver.

Results

There were 21 female patients and mean age was 37.5 years. Among them, 32 patients were healthy living donor. ICG was administrated through peripheral vein in 34 patients, and 38 patients (82.6%) were identified clear ICG demarcation line. Ten patients of them showed similar demarcation line for both gross vision and ICG imaging. In 9 patients, inferior part was similar, however, it was more clearly seen in superior part using ICG imaging. ICG imaging was found to be clearly seen in both inferior/superior part than gross vision in 9 patients. According to administration method, success rate of indirect method was higher than direct method (50% vs. 94.1%, p-value=0.002). In indirect method, 29.4% showed that gross vision and ICG imaging was identical. In 44.1% of patients, ICG imaging clearly seen than gross vision in superior part. In both superior/inferior part, 20.6 % of patients showed visual benefit in ICG imaging.

Conclusion

ICG fluorescent imaging is able to provide more clear images than gross vision in anatomic liver resection. Large cohort and prospective control studies are mandatory to verify the efficacy of ICG guided anatomic liver resection in near future.