| ObjectiveThe accurate surgical navigation of liver tumors is of great significance for the improvement of safety and efficacy in surgical management.In recent years,computer-aided three-dimensional(3D)visualization technology as a morphological imaging method,has been widely used for the surgical navigation in hepatobiliary surgery.Indocyanine green(ICG)molecular fluorescence is a new approach enables real-time imaging of human structures from cellular functional level.In this study,3D visualization combined with ICG molecular fluorescence imaging was applied during the surgery of liver tumors for the surgical navigation from both morphological anatomy and cellular functional level.The value of this navigation mode was evaluated through practical clinical application.MethodsFrom April 2015 to January 2017,31 patients diagnosed as liver tumor were underwent surgical treatments guided by 3D visualization combined with ICG molecular fluorescence imaging in the department of Hepatobiliary Surgery(I),Zhujiang Hospital,Southern Medical University.3D reconstruction and 3D visualization analysis were performed through the 3D visualization system in all patients for the optimizing surgical options.After the injection of ICG(0.25～0.5 mg/kg)through peripheral vein 24 hours before surgery,the location and boundary of liver tumor was identified for the demarcation of pre-resection line through ICG molecular fluorescence imaging.When performing anatomic hepatectomy,a subsequent bolus of 1ml ICG(2.5mg/ml)was injected after the target portal branch was exposed and temporarily clamped.And the boundary of the liver lobe/segment and pre-resection line were demarcated according to the fluorescent signal distribution.Besides,residual tumor and bile leakage in liver cross section were decteted through ICG molecular fluorescence imaging after resection.The maximum diameter of the fluorescent resected tumor and the 3D visualized tumor was compared for evaluating the accuracy of tumor boundary with the use of ICG molecular fluorescence imaging.Results31 patients have obtained structured and stereoscopic 3D visualization models and performed individualized surgical planning.Real-time location and boundery of liver tumors were displayed intraoperatively with the aid of ICG molecular fluorescence imaging.There was no significant difference between the maximal diameter of the fluorescent resected tumor and the 3D visualized tumors(t =-1.874,p = 0.071).The Pearson correlation test showed a high correlation(r = 0.991,P<0.001)between them.The demarcation line of semi-liver was identified through ICG molecular fluorescence imaging in 3 patients.The presentation of the fluorescent dividing lines were clear,complete and three-dimensional,which were consistent with the hepatic ischemic range after blocking the corresponding portal vein and hepatic artery.Residual tumor in liver cross section was found in one case through ICG molecular fluorescence imaging.After expanding the liver resection range,no remnant tumor was discovered by re-fluorescence detection.And the liver resection margin pathological results were negative.The overall result indicated that the fluorescent presentation of liver resection margins were consistent with the intraoperative frozen pathology,RO resection rate was 100%.Besides,bile leakage in liver cross section was found in one case through ICG molecular fluorescence imaging.After closing the bile leakage site,the fluorescent signals were disappeared when performing another detection.And no postoperative bile leakage occurred in this case.The incidence of postoperative bile leakage in this group was 3.2%(1/31).ConclusionsThe technology of 3D visualization combined with ICG molecular fluorescence imaging is able tolocate the liver tumors and define their boundaries and the resection scope in real-time.It can also detect the residual liver tumors and bile leakage in the liver cross section with high sensitivity.Therefore,this technique has a certain practical value in the surgical navigation of liver tumors. |
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