HPB V08 Fluorescence Image Guidance (FIG) in minimally invasive liver surgery- can it help identify deep margins?


 
 
 Despite recent advances in imaging modalities and surgical techniques in liver resection, the rate of R1 resection in liver tumours is still high. Currently, liver surgeons plan the type of liver resection based on information gathered from pre-operative cross-sectional imaging, intraoperative naked eye examination/palpation, and intra-operative ultrasound (IOUS) examination. Naked eye examination and palpation help identify superficially located tumours; however, they do not help localise deeply seated small tumours or accurately mark tumour margins. Moreover, the lack of tactile feedback in the case of laparoscopic liver surgery makes tumour identification further difficult. Currently, IOUS is the most sensitive test for detecting liver tumours – in both open and laparoscopic liver surgery. However, it does not give a real-time visual clue on transection margins. Identification and marking of the deep margin of the tumour are not possible with IOUS. We describe the use of FIG using indocyanine green (ICG) dye in localisation and identification of deep margins of a segment seven liver metastasis.
 
 
 
 We present a video demonstration of the use of FIG in the identification of deep resection margins of a segment seven tumour in a 41 year-old female patient. Initially, the tumour was not visible to the naked eye owing to its location, which made the identification of the tumour and its margins with IOUS challenging. We can see in the video how ICG identified the tumour readily and helped identify the resection margins, especially the deep margin, which was challenging to identify with IOUS. The histology report confirmed that all margins were free of tumours.
 
 
 
 We found that FIG is a robust, objective, real-time navigation tool that can overcome some of the shortfalls associated with and help accurately identify tumour resection margins. When used along with IOUS, we believe that FIG using ICG can potentially reduce R1 resection rates in liver tumours.
 
 
 
 We found that FIG is a robust, objective, real-time navigation tool that can overcome some of the shortfalls associated with and help accurately identify tumour resection margins. When used along with IOUS, we believe that FIG using ICG can potentially reduce R1 resection rates in liver tumours.
