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Multicenter Study
. 2024 Sep;38(9):5108-5113.
doi: 10.1007/s00464-024-11010-7. Epub 2024 Jul 17.

Indocyanine green fluorescence perfusion testing in robot-assisted hepatic arterial infusion pump placement

Roderick W J J van Dorst  1 , Britte H E A Ten Haaft  2 , Stijn Franssen  3 , Inne H M Borel Rinkes  1 , Bas Groot Koerkamp  3 , Rutger-Jan Swijnenburg  2 , Jeroen Hagendoorn  4
Affiliations
Multicenter Study

Indocyanine green fluorescence perfusion testing in robot-assisted hepatic arterial infusion pump placement

Roderick W J J van Dorst et al. Surg Endosc. 2024 Sep.

Abstract

Background: Hepatic arterial infusion pump (HAIP) treatment is a technique used to treat liver localized malignancy with intra-arterial chemotherapy. Methylene blue is generally administered to verify hepatic perfusion and exclude inadvertent extrahepatic perfusion. The use of indocyanine green dye (ICG) combined with near-infrared (NIR) fluorescence imaging during robot-assisted HAIP placement may be an attractive alternative by providing high contrast without blue discoloration of the operative field.

Methods: Data was collected retrospectively from 2 centers in the Netherlands. Intraoperative perfusion of the liver segments and extrahepatic perfusion were assessed using ICG/NIR as well as methylene blue on video imaging and correlated to postoperative 99 m-Tc perfusion scintigraphy.

Results: 13 patients underwent robot-assisted surgery for HAIP placement; median length of stay was 4 days, complications occurred in 4 patients. Hepatic perfusion showed identical patterns when ICG was compared with methylene blue. In 1 patient, additional extrahepatic perfusion was found using ICG, leading to further vessel ligation. Intraoperative ICG perfusion was concordant with 99 m-Tc perfusion scintigraphy.

Discussion: Liver and extrahepatic perfusion determined by ICG fluorescence imaging is concordant with blue dye perfusion and 99 m-Tc perfusion scintigraphy. Therefore, ICG fluorescence imaging is deemed a safe and reliable technique for perfusion testing during robot-assisted HAIP placement.

Keywords: Chemotherapy; Fluorescence; Robot-assisted surgery.

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Conflict of interest statement

Roderick van Dorst, Britte ten Haaft, Stijn Franssen, Inne Borel Rinkes, Bas Groot Koerkamp, Rutger-Jan Swijnenburg and Jeroen Hagendoorn have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
a: Intraoperative view (1: liver, 2: duodenum, 3: stomach), b: Methylene blue, c: ICG fluorescence, d: 99-Nm Technetium scintigraphy (Color figure online)
See this image and copyright information in PMC

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