Advantages of laparoscopic segmentectomy of the liver using ICG fluorescent navigation by the negative staining method: A comparison with open procedure

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of Gastroenterological Surgery Pub Date : 2024-03-07 DOI:10.1002/ags3.12786

Kenichiro Araki, Akira Watanabe, Norifumi Harimoto, Takamichi Igrashi, Mariko Tsukagoshi, Norihiro Ishii, Shunsuke Kawai, Kei Hagiwara, Kouki Hoshino, Ken Shirabe

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Abstract

Aim

Laparoscopic segmentectomy (LS) using indocyanine green (ICG) fluorescence navigation with negative staining method has potential for performing accurate and safe anatomical excision. This study aimed to evaluate the significance of LS using ICG fluorescence navigation compared with open segmentectomy (OS).

Methods

Eighty-seven patients who underwent anatomical segmentectomies were evaluated for OS (n = 44) and LS (n = 43). The Glissonean pedicle approach was performed using either extra- or intrahepatic method, depending on the location of segment in LS. After clamping pedicle, negative staining method was performed. Liver transection was done along intersegmental plane visualizing by overlay mode of ICG camera. Surgical outcomes were compared between two groups. Correlation between predicted resecting liver volume (PRLV) calculated using volumetry and actual resected liver volume (ARLV) was assessed in two groups.

Results

Patients who underwent LS showed better outcomes in operative time, blood loss, and length of hospital stay. There were significantly fewer Grade II and Grade III or higher postoperative complications in LS group. Both values of AST (p < 0.001) and ALT (p < 0.001) on postoperative day 1 were significantly lower in LS group than in OS group. PRLV and ARLV were more strongly correlated in LS (r = 0.896) than in OS (r = 0.773). The difference between PRLV and ARLV was significantly lower in LS group than in OS group (p = 0.022), and this trend was particularly noticeable in posterosuperior segment (p = 0.008) than in anterolateral segment (p = 0.811).

Conclusion

LS using ICG navigation allows precise resection and may contribute to safer short-term outcomes than OS, particularly in posterosuperior segment.

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利用ICG荧光导航阴性染色法进行腹腔镜肝段切除术的优势：与开腹手术的比较

使用吲哚青绿（ICG）荧光导航和阴性染色法的腹腔镜节段切除术（LS）具有进行准确、安全的解剖切除的潜力。这项研究旨在评估使用ICG荧光导航的LS与开放式节段切除术（OS）相比的意义。87名接受解剖节段切除术的患者接受了OS（44人）和LS（43人）的评估。根据LS节段的位置，采用肝外或肝内方法进行Glissonean梗管切口。钳夹肝蒂后，采用阴性染色法。沿肝段间平面进行肝横断，通过 ICG 相机的叠加模式进行观察。比较两组的手术结果。两组患者在手术时间、失血量和住院时间方面的疗效更好。LS组患者的II级和III级以上术后并发症明显较少。LS组术后第1天的AST（p < 0.001）和ALT（p < 0.001）值均明显低于OS组。LS 组 PRLV 和 ARLV 的相关性（r = 0.896）高于 OS 组（r = 0.773）。LS组的PRLV和ARLV之间的差异明显低于OS组（p = 0.022），这一趋势在后上段（p = 0.008）比前外侧段（p = 0.811）尤为明显。

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