Файловый архив студентов. Файловый архив студентов.
1327 вузов, 5482 предметов.
/ Регистрация
FAQ Обратная связь Вопросы и предложения
Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Ростовский Государственный Медицинский Университет
Предмет:
Медицина общая
Файл:

Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 715 - файл

.pdf
Скачиваний:
0
Добавлен:
29.08.2026
Размер:
16 Мб
Скачать
☆
148
https://t.me/medicina_free
Fig. 5.9 Ischemic demarcation of the right lobe of the liver following bull­dog clamp application to the right hepatic artery under white light
I. Sucandy et al.
Fig. 5.10 Ischemic demarcation of the right lobe of the liver following bull­dog clamp application to the right hepatic artery under ICG uorescence
5 Use ofFluorescence Guidance inHepatic Surgery
https://t.me/medicina_free
Fig. 5.11 Left lobe of the liver status post right hepatectomy with no sig­nicant ischemic tissue left behind under white light
149
Prediction ofPosthepatectomy Liver Failure
The fourth application of ICG relates to its application in pre­dicting posthepatectomy liver failure (PHLF). The details, con­sequences, and ultimate outcomes of this unfortunate condition require its own textbook, let alone chapter. Nonetheless, based on the International Study Group of Liver Surgeries denition, we may dene it as an acquired failure of hepatic synthetic, excretionary, and detoxifying functions after liver resection as reected by rises in bilirubin and international normalized ratio (INR) [53] (Level V). ICG clearance is an attractive predictor of PHLF [29] (Level IV), which enables curative anatomic seg­mentectomies of the liver even in patients with portal hyperten­sion [54] (Level IV). Its clearance depends on hepatic synthetic and biliary excretion function as mentioned previously, which can be quantied by its uorescence; more uorescent liver parenchyma is indicative of greater parenchymal dysfunction.
150
https://t.me/medicina_free
I. Sucandy et al.
In a study involving 284 major hepatectomies for bile duct can­cer, an ICG retention of >11.8% was predictive of a life-threat­ening complication (Clavien-Dindo Classication ≥ IV complication) [55] (Level IV). A more novel approach utilizes future liver remnant ICG clearance; intraoperative ICG reten­tion >13.8% by the future remnant liver during specimen pedi­cle clamping was 79.7% accurate in predicting PHLF in a study of 35 major liver resections [56] (Level IV). If retention >13.8% is noted, the surgeon can unclamp the specimen pedicle and abort the operation.
At our tertiary hepatobiliary institution, we do not routinely utilize ICG clearance preoperatively nor intraoperatively for selecting candidates for hepatectomy. Along the lines of Makuuchi’s decisional algorithm, we are hesitant to offer major liver resection to patients with total bilirubin greater than 1mg/dL in the absence of biliary obstruction nor in the presence of uncon­trolled or signicant ascites. We also are hesitant to offer major resection if the platelet count is less than 100,000 per microliter or in the presence of signicant varices as this reects signicant portal hypertension and an inability of the future liver remnant to accommodate further increases in portal venous ow. In candi­dates with borderline features, we will attempt medical optimiza­tion or initiate a referral to a transplant center.
Finally, there are a few other functions that are deserving of mention. HCC has an afnity for ICG beyond mere degrada­tion and excretion [21]. It is possible that photodynamic ther­apy and other targeted regimens based on the afnity for ICG can be implemented in the near future, which will expand ana­tomical treatment options for nonsurgical candidates who are unable to attain a liver transplant [57, 58]. Newer technologies have been developed to increase the accuracy of uorescence imaging in distinguishing malignancies from benign dysfunc­tional liver parenchyma based on cancer-specic enzymatic activities [59] and biomarkers [60], molecular targeting, and single photon emission computed tomography [61]. Clinical trials to enroll patients in real-time ICG-guided liver surgery are underway [62].
5 Use ofFluorescence Guidance inHepatic Surgery
https://t.me/medicina_free
151
Conclusion
In conclusion, the liver is an anatomically complex organ, consist­ing of varying vascular and biliary structures. Precise hepatic tumor localization and surgical margin assessment adds further technical difculty, particularly in parenchyma-sparing hepatec­tomy. Application of ICG permits biliary and vascular identica­tion and selective manipulation. Hepatic synthesis and biliary excretion permits functional assessment of candidate patients prior to major hepatic resection, while the degraded ability of can­cerous or dysfunctional liver to metabolize ICG permits its utili­zation in hepatic malignant lesion targeting. Careful timing, dosage, and application of ICG can increase sensitivity and speci­city of cancer imaging, which may enhance curability after hep­atobiliary operations. While the current expert panels have reached consensus on intraoperative uorescence imaging utilization [31, 63], continued research elucidating the impact of uorescence guidance imaging on clinical outcomes is required to generate higher level of evidence.
References
1. Shapera E, Hsiung RW. Assessment of anastomotic perfusion in left­sided robotic assisted colorectal resection by Indocyanine green uores­cence angiography. Minim Invasive Surg. 2019;2019:3267217.
2. Reinhart MB, Huntington CR, Blair LJ, Heniford BT, Augenstein VA. Indocyanine green: historical context, current applications, and future considerations. Surg Innov. 2016;23:166–75.
3. Cherrick GR, Stein SW, Leevy CM, Davidson CS.Indocyanine green: observations on its physical properties, plasma decay, and hepatic extrac­tion. J Clin Invest. 1960;39:592–600.
4. Chijiiwa K, Watanabe M, Nakano K, Noshiro H, Tanaka M.Biliary indo­cyanine green excretion as a predictor of hepatic adenosine triphosphate levels in patients with obstructive jaundice. Am J Surg. 2000;179:161–6.
5. Ishizawa T, Tamura S, Masuda K, Aoki T, Hasegawa K, Imamura H, Beck Y, Kokudo N.Intraoperative uorescent cholangiography using indocya­nine green: a biliary road map for safe surgery. J Am Coll Surg. 2009;208:e1–4.
152
https://t.me/medicina_free
6. Mitsuhashi N, Kimura F, Shimizu H, Imamaki M, Yoshidome H, Ohtsuka M, Kato A, Yoshitomi H, Nozawa S, Furukawa K, Takeuchi D, Takayashiki T, Suda K, Igarashi T, Miyazaki M.Usefulness of intraoperative uores­cence imaging to evaluate local anatomy in hepatobiliary surgery. J Hepatobiliary Pancreat Surg. 2008;15:508–14.
7. Ishizawa T, Bandai Y, Kokudo N. Fluorescent cholangiography using indocyanine green for laparoscopic cholecystectomy: an initial experi­ence. Arch Surg. 2009;144:381–2.
8. Ishizawa T, Bandai Y, Ijichi M, Kaneko J, Hasegawa K, Kokudo N.Fluorescent cholangiography illuminating the biliary tree during lapa­roscopic cholecystectomy. Br J Surg. 2010 Sep;97(9):1369–77.
9. Agnus V, Pesce A, Boni L, Van Den Bos J, Morales-Conde S, Paganini AM, Quaresima S, Balla A, La Greca G, Plaudis H, Moretto G, Castagnola M, Santi C, Casali L, Tartamella L, Saadi A, Picchetto A, Arezzo A, Marescaux J, Diana M. Fluorescence-based cholangiography: prelimi­nary results from the IHU-IRCAD-EAES EURO-FIGS registry. Surg Endosc. 2020;34(9):3888–96.
10. Dip F, LoMenzo E, Sarotto L, Phillips E, Todeschini H, Nahmod M, Alle L, Schneider S, Kaja L, Boni L, Ferraina P, Carus T, Kokudo N, Ishizawa T, Walsh M, Simpfendorfer C, Mayank R, White K, Rosenthal RJ. Randomized trial of near-infrared incisionless uorescent cholangi­ography. Ann Surg. 2019;270(6):992–9.
11. Lehrskov LL, Westen M, Larsen SS, Jensen AB, Kristensen BB, Bisgaard T.Fluorescence or X-ray cholangiography in elective laparoscopic chole­cystectomy: a randomized clinical trial. Br J Surg. 2020;107:655–61.
12. Kaibori M, Ishizaki M, Matsui K, Kwon AH.Intraoperative indocyanine green uorescent imaging for prevention of bile leakage after hepatic resection. Surgery. 2011;150:91–8.
13. Marino MV, Builes Ramirez S, Gomez Ruiz M. The application of Indocyanine green (ICG) staining technique during robotic-assisted right hepatectomy: with video. J Gastrointest Surg. 2019;23:2312–3.
14. Brunt LM, Deziel DJ, Telem DA, Strasberg SM, Aggarwal R, Asbun H, Bonjer J, McDonald M, Alseidi A, Ujiki M, Riall TS, Hammill C, Moulton CA, Pucher PH, Parks RW, Ansari MT, Connor S, Dirks RC, Anderson B, Altieri MS, Tsamalaidze L, Stefanidis D, The Prevention of Bile Duct Injury Consensus Work Group. Safe cholecystectomy multi­society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Ann Surg. 2020;272:3–23.
15. Schols RM, Bouvy ND, van Dam RM, Masclee AAM, Dejong CHC, Stassen LPS. Combined vascular and biliary uorescence imaging in laparoscopic cholecystectomy. Surg Endosc. 2013;27:4511–7.
16. Gené Škrabec C, Pardo Aranda F, Espín F, Cremades M, Navinés J, Zárate A, Cugat E.Fluorescent cholangiography with direct injection of
I. Sucandy et al.
5 Use ofFluorescence Guidance inHepatic Surgery
https://t.me/medicina_free
indocyanine green (ICG) into the gallbladder: a safety method to outline biliary anatomy. Langenbecks Arch Surg. 2020;405:827–32.
17. Sucandy I, Luberice K, Lippert T, Castro M, Krill E, Ross S, Rosemurgy A.Robotic major hepatectomy: an institutional experience and clinical outcomes. Ann Surg Oncol. 2020;27:4970–9.
18. Sucandy I, Giovannetti A, Ross S, Rosemurgy A.Institutional rst 100 case experience and outcomes of robotic hepatectomy for liver tumors. Am Surg. 2020;86:200–7.
19. Sucandy I, Schlosser S, Bourdeau T, Spence J, Attili A, Ross S, Rosemurgy A. Robotic hepatectomy for benign and malignant liver tumors. J Robot Surg. 2020;14:75–80.
20. Kim J, Hong SK, Lim J, Lee JM, Cho JH, Choi Y, Yi NJ, Lee KW, Suh KS.Demarcating the exact midplane of the liver using Indocyanine green near-infrared uorescence imaging during laparoscopic donor hepatec­tomy. Liver Transpl. 2021;27(6):830–9.
21. Ishizawa T, Fukushima N, Shibahara J, Masuda K, Tamura S, Aoki T, Hasegawa K, Beck Y, Fukayama M, Kokudo N.Real-time identication of liver cancers by using indocyanine green uorescent imaging. Cancer. 2009;115:2491–504.
22. Lim C, Vibert E, Azoulay D, etal. Indocyanine green uorescence imag­ing in the surgical management of liver cancers: current facts and future implications. J Visc Surg. 2014;151:117–24.
23. Ishizawa T, Masuda K, Urano Y, etal. Mechanistic background and clini­cal applications of indocyanine green-uorescence imaging of hepatocel­lular carcinoma. Ann Surg Oncol. 2014;21:440–8.
24. Achterberg FB, Sibinga Mulder BG, Meijer RPJ, etal. Real-time surgical margin assessment using ICG-uorescence during laparoscopic and robot-assisted resections of colorectal liver metastases. Ann Transl Med. 2020;8:1448.
25. van der Vorst JR, Schaafsma BE, Hutteman M, et al. Near-infrared uorescence- guided resection of colorectal liver metastases. Cancer. 2013;119:3411–8.
26. Gotoh K, Yamada T, Ishikawa O, Takahashi H, Eguchi H, Yano M, Ohigashi H, Tomita Y, Miyamoto Y, Imaoka S. A novel image-guided surgery of hepatocellular carcinoma by indocyanine green uorescence imaging navigation. J Surg Oncol. 2009;100:75–9.
27. Terasawa M, Ishizawa T, Saiura A, etal. Applications of fusion uores­cence imaging using indocyanine green in laparoscopic hepatectomy. Surg Endosc. 2017;31:5111–8.
28. Kudo H, Ishizawa T, Tani K, etal. Visualization of subcapsular hepatic malignancy by indocyanine-green uorescence imaging during laparo­scopic hepatectomy. Surg Endosc. 2014;28:2504–8.
29. Makuuchi M, Kosuge T, Takayama T, etal. Surgery for small liver can­cers. Semin Surg Oncol. 1993;9:298–304.
153
154
https://t.me/medicina_free
30. Achterberg FB, Sibinga Mulder BG, Meijer RPJ, Bonsing BA, Hartgrink HH, Mieog JSD, Zlitni A, Park SM, Farina Sarasqueta A, Vahrmeijer AL, Swijnenburg RJ. Real-time surgical margin assessment using ICG­uorescence during laparoscopic and robot-assisted resections of colorec­tal liver metastases. Ann Transl Med. 2020;8(21):1448.
31. Zhang P, Luo H, Zhu W, Yang J, Zeng N, Fan Y, Wen S, Xiang N, Jia F, Fang C.Real-time navigation for laparoscopic hepatectomy using image fusion of preoperative 3D surgical plan and intraoperative indocyanine green uorescence imaging. Surg Endosc. 2020;34(8):3449–59.
32. Xu LX, He MH, Dai ZH, etal. Genomic and transcriptional heterogene­ity of multifocal hepatocellular carcinoma. Ann Oncol. 2019;30:990–7.
33. Møller S, la Cour SE, Madsen JL, Bendtsen F.Indocyanine green reten­tion test in cirrhosis and portal hypertension: accuracy and relation to severity of disease. J Gastroenterol Hepatol. 2019;34:1093–9.
34. Langella S, Ardito F, Russolillo N, Panettieri E, Perotti S, Mele C, Giuliante F, Ferrero A.Intraoperative ultrasound staging for colorectal liver metastases in the era of liver-specic magnetic resonance imaging: is it still worthwhile? J Oncol. 2019;2019:1369274.
35. Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs AK.Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC.Cancer Treat Rev. 2007;33:437–47.
36. Aoki T, Murakami M, Koizumi T, Matsuda K, Fujimori A, Kusano T, Enami Y, Goto S, Watanabe M, Otsuka K.Determination of the surgical margin in laparoscopic liver resections using infrared indocyanine green uorescence. Langenbecks Arch Surg. 2018;403(5):671–80.
37. Lu H, Gu J, Qian XF, Dai XZ.Indocyanine green uorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases. Surg Today. 2021;51(5):695–702.
38. Lu H, Gu J, Qian XF, Dai XZ.Indocyanine green uorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases. Surg Today. 2021;51(5):695–702. https://doi.org/10.1007/s00595-
020- 02163- 8.
39. Handgraaf HJM, Boogerd LSF, Höppener DJ, Peloso A, Sibinga Mulder BG, Hoogstins CES, Hartgrink HH, van de Velde CJH, Mieog JSD, Swijnenburg RJ, Putter H, Maestri M, Braat AE, Frangioni JV, Vahrmeijer AL.Long-term follow-up after near-infrared uorescence-guided resec­tion of colorectal liver metastases: a retrospective multicenter analysis. Eur J Surg Oncol. 2017;43(8):1463–71.
40. Wada H, Eguchi H, Nagano H, etal. Perioperative allogenic blood trans­fusion is a poor prognostic factor after hepatocellular carcinoma surgery: a multi-center analysis. Surg Today. 2018;48:73–9.
41. Fang CH, Zhang P, Luo HL, etal. Application of augmented-reality surgi­cal navigation technology combined with ICG molecular uorescence imaging in laparoscopic hepatectomy. Zhonghua Wai Ke Za Zhi. 2019;57:578–84.
I. Sucandy et al.
5 Use ofFluorescence Guidance inHepatic Surgery
https://t.me/medicina_free
42. Aoki T, Yasuda D, Shimizu Y, Odaira M, Niiya T, Kusano T, Mitamura K, Hayashi K, Murai N, Koizumi T, Kato H, Enami Y, Miwa M, Kusano M. Image-guided liver mapping using uorescence navigation system with indocyanine green for anatomical hepatic resection. World J Surg. 2008;32(8):1763–7.
43. Ishizawa T, Zuker NB, Kokudo N, Gayet B.Positive and negative stain­ing of hepatic segments by use of uorescent imaging techniques during laparoscopic hepatectomy. Arch Surg. 2012;147:393–4.
44. Makuuchi M, Hasegawa H, Yamazaki S.Ultrasonically guided subseg­mentectomy. Surg Gynecol Obstet. 1985;161:346–50.
45. Takasaki K.Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg. 1998;5:286–91.
46. Aoki T, Koizumi T, Mansour DA, Fujimori A, Kusano T, Matsuda K, Tashiro Y, Watanabe M, Otsuka K, Murakami M.Ultrasound-guided pre­operative positive percutaneous Indocyanine green uorescence staining for laparoscopic anatomical liver resection. J Am Coll Surg. 2020;230:e7– e12.
47. Xu Y, Chen M, Meng X, Lu P, Wang X, Zhang W, Luo Y, Duan W, Lu S, Wang H. Laparoscopic anatomical liver resection guided by real-time indocyanine green uorescence imaging: experience and lessons learned from the initial series in a single center. Surg Endosc. 2020;34(10):4683–
91.
48. Chiow AKH, Rho SY, Wee IJY, Lee LS, Choi GH.Robotic ICG guided anatomical liver resection in a multi-Centre cohort: an evolution from “positive staining” into “negative staining” method. HPB (Oxford). 2021;23(3):475–82.
49. Wang X, Teh CSC, Ishizawa T, Aoki T, Cavallucci D, Lee SY, Panganiban KM, Perini MV, Shah SR, Wang H, Xu Y, Suh KS, Kokudo N.Consensus guidelines for the use of uorescence imaging in hepatobiliary surgery. Ann Surg. 2021;274(1):97–106.
50. Nishino H, Seo S, Hatano E, Nitta T, Morino K, Toda R, Fukumitsu K, Ishii T, Taura K, Uemoto S.What is a precise anatomic resection of the liver? Proposal of a new evaluation method in the era of uorescence navigation surgery. J Hepatobiliary Pancreat Sci. 2021;28(6):479–88. Epub 2020 Oct 4. https://doi.org/10.1002/jhbp.824.
51. Zhu K-S, Meng X-C, Huang M-S, Qian J-S, Guan S-H, Li Z-R, Jiang Z-B, Shan H, Yang Y, Chen G-H.The role of early hepatic artery ischemia on biliary complications after liver transplantation and hepatic arterial interventional therapy. Zhonghua Yi Xue Za Zhi. 2009;89:2195–8.
52. Hasegawa K, Kokudo N, Imamura H, etal. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg. 2005;242:252–9.
53. Ray S, Mehta NN, Golhar A, Nundy S.Post hepatectomy liver failure- a comprehensive review of current concepts and controversies. Ann Med Surg (Lond). 2018;34:4–10.
155
156
https://t.me/medicina_free
54. Ishizawa T, Hasegawa K, Aoki T, Takahashi M, Inoue Y, Sano K, Imamura H, Sugawara Y, Kokudo N, Makuuchi M.Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular car­cinoma. Gastroenterology. 2008;134(7):1908–16.
55. Kuboki S, Furukawa K, Takayashiki T, Takano S, Miyazaki M, Ohtsuka M.Clinical implication of ICG test in major hepatectomy for biliary tract cancer. Minerva Surg. 2021;76:202–10.
56. Wang L, Xie L, Zhang N, Zhu W, Zhou J, Pan Q, Mao A, Lin Z, Wang L, Zhao Y. Predictive value of intraoperative Indocyanine green clearance measurement on postoperative liver function after anatomic major liver resection. J Gastrointest Surg. 2020;24:1342–51.
57. Kaneko J, Kokudo T, Inagaki Y, Hasegawa K.Innovative treatment for hepatocellular carcinoma (HCC). Transl Gastroenterol Hepatol. 2018;3:78.
58. Kaneko J, Inagaki Y, Ishizawa T, Gao J, Tang W, Aoki T, Sakamoto Y, Hasegawa K, Sugawara Y, Kokudo N.Photodynamic therapy for human hepatoma-cell-line tumors utilizing biliary excretion properties of indo­cyanine green. J Gastroenterol. 2014;49(1):110–6.
59. Miyata Y, Ishizawa T, Kamiya M, Yamashita S, Hasegawa K, Ushiku A, Shibahara J, Fukayama M, Urano Y, Kokudo N.Intraoperative imaging of hepatic cancers using γ-glutamyltranspeptidase-specic uorophore enabling real-time identication and estimation of recurrence. Sci Rep. 2017;7(1):3542.
60. Meijer RPJ, de Valk KS, Deken MM, Boogerd LSF, Hoogstins CES, Bhairosingh SS, Swijnenburg RJ, Bonsing BA, Framery B, Fariña Sarasqueta A, Putter H, Hilling DE, Burggraaf J, Cailler F, Mieog JSD, Vahrmeijer AL.Intraoperative detection of colorectal and pancreatic liver metastases using SGM-101, a uorescent antibody targeting CEA.Eur J Surg Oncol. 2021;47(3 Pt B):667–73.
61. Iimuro Y.ICG clearance test and 99mTc-GSA SPECT/CT fusion images. Visc Med. 2017;33:449–54.
62. Gon H, Komatsu S, Murakami S, Kido M, Tanaka M, Kuramitsu K, Tsugawa D, Awazu M, Toyama H, Fukumoto T. Real-time navigation during hepatectomy using fusion indocyanine green-uorescence imag­ing: protocol for a prospective cohort study. BMJ Open. 2019;9:e030233.
63. Dip F, Boni L, Bouvet M, Carus T, Diana M, Falco J, Gurtner GC, Ishizawa T, Kokudo N, Lo Menzo E, Low PS, Masia J, Muehrcke D, Papay FA, Pulitano C, Schneider-Koraith S, Sherwinter D, Spinoglio G, Stassen L, Urano Y, Vahrmeijer A, Vibert E, Warram J, Wexner SD, White K, Rosenthal RJ.Consensus conference statement on the general use of near-infrared uorescence imaging and Indocyanine green guided sur­gery: results of a modied Delphi study. Ann Surg. 2020;275:685. Epub ahead of print. PMID: 33214476. https://doi.org/10.1097/
SLA.0000000000004412.
I. Sucandy et al.
Use ofFluorescence
https://t.me/medicina_free
Guidance inEndocrine Surgery
JaredMatson, ThinzarM.Lwin, andMichaelBouvet
Introduction
Surgeon interest in uorescence-guided surgery (FGS) has existed since at least the 1950s. Some of the earliest applications were in ophthalmology and cataract surgery, although there was interest in applying the technology to gynecologic and hepatobi­liary surgery as well [1–3]. While there were attempts at applying uorescence in various surgical applications over the next ve decades, including vascular surgery, thoracic surgery, otolaryn­gology, and more, the advent of high-quality commercially
J. Matson Department of Surgery, UC San Diego, San Diego, CA, USA e-mail: jsmatson@health.ucsd.edu
T. M. Lwin Department of Surgery, UC San Diego, San Diego, CA, USA
Department of Surgical Oncology, Dana Farber Cancer Center, Boston, MA, USA e-mail: thinzar_lwin@dfci.harvard.edu
M. Bouvet (*) Department of Surgery, UC San Diego, San Diego, CA, USA
VA San Diego Healthcare System, San Diego, CA, USA e-mail: mbouvet@health.ucsd.edu
6
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 N. Szoka et al. (eds.), The SAGES Manual of Fluorescence-Guided Surgery, https://doi.org/10.1007/978-3-031-40685-0_6
157
Соседние файлы в папке @xirurgi_2025
Помощь Обратная связь Вопросы и предложения Пользовательское соглашение Политика конфиденциальности