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. 2022 Jun 19;11(12):3527.
doi: 10.3390/jcm11123527.

The Role of ICG in Robot-Assisted Liver Resections

Anne-Sophie Mehdorn  1 , Florian Richter  1 , Katharina Hess  2 , Jan Henrik Beckmann  1 , Jan-Hendrik Egberts  3 , Michael Linecker  1 , Thomas Becker  1 , Felix Braun  1
Affiliations

The Role of ICG in Robot-Assisted Liver Resections

Anne-Sophie Mehdorn et al. J Clin Med. .

Abstract

Introduction: Robotic-assisted liver surgery (RALS) with its known limitations is gaining more importance. The fluorescent dye, indocyanine green (ICG), is a way to overcome some of these limitations. It accumulates in or around hepatic masses. The integrated near-infrared cameras help to visualize this accumulation. We aimed to compare the influence of ICG staining on the surgical and oncological outcomes in patients undergoing RALS. Material and Methods: Patients who underwent RALS between 2014 and 2021 at the Department of General Surgery at the University Hospital Schleswig-Holstein, Campus Kiel, were included. In 2019, ICG-supported RALS was introduced. Results: Fifty-four patients were included, with twenty-eight patients (50.9%) receiving preoperative ICG. Hepatocellular carcinoma (32.1%) was the main entity resected, followed by the metastasis of colorectal cancers (17%) and focal nodular hyperplasia (15.1%). ICG staining worked for different tumor entities, but diffuse staining was noted in patients with liver cirrhosis. However, ICG-supported RALS lasted shorter (142.7 ± 61.8 min vs. 246.4 ± 98.6 min, p < 0.001), tumors resected in the ICG cohort were significantly smaller (27.1 ± 25.0 mm vs. 47.6 ± 35.2 mm, p = 0.021) and more R0 resections were achieved by ICG-supported RALS (96.3% vs. 80.8%, p = 0.075). Conclusions: ICG-supported RALS achieve surgically and oncologically safe results, while overcoming the limitations of RALS.

Keywords: ICG; hepatic surgery; indocyanine green; liver surgery; minimally invasive hepatic surgery; robot-assisted hepatic surgery; robotic hepatic surgery; robotic liver surgery; robotic surgery.

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Conflict of interest statement

J.H.B. is active as speaker for Johnson & Johnson Medical. J.H.B., T.B. and J.H.E. received grants for training with the da Vinci Xi Surgical System through Intuitive Surgical Sàrl. J.H.B. and J.H.E. work as proctors for Intuitive Surgical Sàrl. The sponsors had no role in the design, execution, interpretation or writing of the study. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Intra-operative robotic image in white light (C) and intraoperative near-infrared (D) image of CRLM (rim phenomenon) with corresponding preoperative T-weight MRI-scans (A,B)
Figure 2
Figure 2
Intra-operative near-infrared image (A,C) and normal white light image (B,D) with the corresponding image of the IOUS of unequivocal staining (A,C) of a HCC, corresponding with the IOUS (HCC) and diffuse staining and not corresponding with the ICG-based image (C,D) of a CCC.
Figure 3
Figure 3
Intra-operative fluorescence imaging and histopathological image of the corresponding area confirming R0 resection. Histological images of tumor free liver tissue in the marginal area with portal fields and a sparse round cell infiltrate (A) HE staining, magnification 200×. Histological images of HCC with trabecular and pseudoglandular growth from the same patient (B) HE staining, magnification 200×. Intraoperative imaging of the fluorescent tumor after ICG application (C), preoperative MRI scan, showing the lesion (D).
See this image and copyright information in PMC

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