Clinical application of the video fluorescent mapping method in the preoperative planning of liver resections in its focal diseases

• Vladislav S. Subbot
• Alexey V. Semenkov
• Shiryayev A.A.
• Tatiana P. Nekrasova
• Grachov P.V.
• Farrakhova D.S.
• Loshchenov V.B.
• Bodyrev M.A.
• Yudayev N.D.

Abstract

Background. Modern methods of visualization and navigation used in liver surgery are aimed to ensure the radicality and safety of surgical intervention. One of the actual methods aimed at solving these problems is video fluorescence mapping of liver tumors using indocyanine green (ICG). Despite the disadvantages of the method, the integrated use of ICG mapping with other navigation methods can potentially improve the results of the intervention. Thus, ICG-navigation surgery seems to be a promising direction in liver surgery, which is the subject of this study.

Aim - analysis of the clinical application of fluorescent diagnostics in resections of focal liver formations.

Material and methods. A pilot single-center prospective cohort study of 8 patients who underwent liver resection in different volumes was conducted. All included patients had morphologically verified secondary liver damage in the absence of other diseases in the anamnesis. ICG-fluorescence imaging of focal formations was performed by evaluating the relative brightness of the fluorescence of the contrast agent. The drug was administered systemically 24 h before the operation and intraoperatively in the pathological focus. The brightness of the glow was evaluated in the pathological focus, the zone of transient brightness of the glow, and the unchanged tissue. 

Results. The average duration of the operation was 275 min. The average blood loss was 212 ml. The average postoperative hospital stay was 10 days. In all cases, a negative edge of resection was obtained during pathohistological examination. In the tissue taken from the zone of transient luminosity, no tumor cells were obtained in 5 cases, and in 3 cases, micro-complexes of tumor cells were detected in the lumen of the sinusoids.

Conclusion. The results obtained indicate a positive effect of the use of the ICG-video fluorescence mapping method on the immediate results of liver resection. This method complements the existing methods of intraoperative navigation and allows for more confident use of parenchymal preservation operations, thanks to improved marking of the resection plane.

Keywords:liver, liver resection, preoperative planning, ICG-video fluorescence mapping

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