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Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from Germany

OBJECTIVES: Indocyanine green (ICG) is a fluorescent dye which was initially used for liver functional assessment. Moreover, it is of value for intraoperative visualization of liver segments and bile ducts or primary and secondary liver tumors. Especially in minimally invasive liver surgery, this is...

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Autores principales: Franz, Mareike, Arend, Jörg, Wolff, Stefanie, Perrakis, Aristotelis, Rahimli, Mirhasan, Negrini, Victor-Radu, Stockheim, Jessica, Lorenz, Eric, Croner, Roland
Formato: Online Artículo Texto
Lenguaje:English
Publicado: De Gruyter 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435269/
https://www.ncbi.nlm.nih.gov/pubmed/34589573
http://dx.doi.org/10.1515/iss-2020-0019
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author Franz, Mareike
Arend, Jörg
Wolff, Stefanie
Perrakis, Aristotelis
Rahimli, Mirhasan
Negrini, Victor-Radu
Stockheim, Jessica
Lorenz, Eric
Croner, Roland
author_facet Franz, Mareike
Arend, Jörg
Wolff, Stefanie
Perrakis, Aristotelis
Rahimli, Mirhasan
Negrini, Victor-Radu
Stockheim, Jessica
Lorenz, Eric
Croner, Roland
author_sort Franz, Mareike
collection PubMed
description OBJECTIVES: Indocyanine green (ICG) is a fluorescent dye which was initially used for liver functional assessment. Moreover, it is of value for intraoperative visualization of liver segments and bile ducts or primary and secondary liver tumors. Especially in minimally invasive liver surgery, this is essential to enhance the precision of anatomical guided surgery and oncological quality. As early adopters of ICG implementation into laparoscopic and robotic-assisted liver surgery in Germany, we summarize the current recommendations and share our experiences. METHODS: Actual strategies for ICG application in minimally invasive liver surgery were evaluated and summarized during a review of the literature. Experiences in patients who underwent laparoscopic or robotic-assisted liver surgery with intraoperative ICG staining between 2018 and 2020 from the Magdeburg registry for minimally invasive liver surgery (MD-MILS) were evaluated and the data were analyzed retrospectively. RESULTS: ICG can be used to identify anatomical liver segments by fluorescence angiography via direct or indirect tissue staining. Fluorescence cholangiography visualizes the intra- and extrahepatic bile ducts. Primary and secondary liver tumors can be identified with a sensitivity of 69–100%. For this 0.5 mg/kg body weight ICG must be applicated intravenously 2–14 days prior to surgery. Within the MD-MILS we identified 18 patients which received ICG for intraoperative tumor staining of hepatocellular carcinoma (HCC), cholangiocarcinoma, peritoneal HCC metastases, adenoma, or colorectal liver metastases. The sensitivity for tumor staining was 100%. In 27.8% additional liver tumors were identified by ICG fluorescence. In 39% a false positive signal could be detected. This occurred mainly in cirrhotic livers. CONCLUSIONS: ICG staining is a simple and useful tool to assess individual hepatic anatomy or to detect tumors during minimally invasive liver surgery. It may enhance surgical precision and improve oncological quality. False-positive detection rates of liver tumors can be reduced by respecting the tumor entity and liver functional impairments.
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spelling pubmed-84352692021-09-28 Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from Germany Franz, Mareike Arend, Jörg Wolff, Stefanie Perrakis, Aristotelis Rahimli, Mirhasan Negrini, Victor-Radu Stockheim, Jessica Lorenz, Eric Croner, Roland Innov Surg Sci Original Article OBJECTIVES: Indocyanine green (ICG) is a fluorescent dye which was initially used for liver functional assessment. Moreover, it is of value for intraoperative visualization of liver segments and bile ducts or primary and secondary liver tumors. Especially in minimally invasive liver surgery, this is essential to enhance the precision of anatomical guided surgery and oncological quality. As early adopters of ICG implementation into laparoscopic and robotic-assisted liver surgery in Germany, we summarize the current recommendations and share our experiences. METHODS: Actual strategies for ICG application in minimally invasive liver surgery were evaluated and summarized during a review of the literature. Experiences in patients who underwent laparoscopic or robotic-assisted liver surgery with intraoperative ICG staining between 2018 and 2020 from the Magdeburg registry for minimally invasive liver surgery (MD-MILS) were evaluated and the data were analyzed retrospectively. RESULTS: ICG can be used to identify anatomical liver segments by fluorescence angiography via direct or indirect tissue staining. Fluorescence cholangiography visualizes the intra- and extrahepatic bile ducts. Primary and secondary liver tumors can be identified with a sensitivity of 69–100%. For this 0.5 mg/kg body weight ICG must be applicated intravenously 2–14 days prior to surgery. Within the MD-MILS we identified 18 patients which received ICG for intraoperative tumor staining of hepatocellular carcinoma (HCC), cholangiocarcinoma, peritoneal HCC metastases, adenoma, or colorectal liver metastases. The sensitivity for tumor staining was 100%. In 27.8% additional liver tumors were identified by ICG fluorescence. In 39% a false positive signal could be detected. This occurred mainly in cirrhotic livers. CONCLUSIONS: ICG staining is a simple and useful tool to assess individual hepatic anatomy or to detect tumors during minimally invasive liver surgery. It may enhance surgical precision and improve oncological quality. False-positive detection rates of liver tumors can be reduced by respecting the tumor entity and liver functional impairments. De Gruyter 2021-04-22 /pmc/articles/PMC8435269/ /pubmed/34589573 http://dx.doi.org/10.1515/iss-2020-0019 Text en © 2021 Mareike Franz et al., published by De Gruyter, Berlin/Boston https://creativecommons.org/licenses/by/4.0/This work is licensed under the Creative Commons Attribution 4.0 International License.
spellingShingle Original Article
Franz, Mareike
Arend, Jörg
Wolff, Stefanie
Perrakis, Aristotelis
Rahimli, Mirhasan
Negrini, Victor-Radu
Stockheim, Jessica
Lorenz, Eric
Croner, Roland
Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from Germany
title Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from Germany
title_full Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from Germany
title_fullStr Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from Germany
title_full_unstemmed Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from Germany
title_short Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from Germany
title_sort tumor visualization and fluorescence angiography with indocyanine green (icg) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from germany
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435269/
https://www.ncbi.nlm.nih.gov/pubmed/34589573
http://dx.doi.org/10.1515/iss-2020-0019
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