Name: fluorescent laparoscopic central hepatectomy for liver cancer using indocyanine green negative staining
Uploaded: 2023-03-17T14:30:00
Description: Watch this Scientific Journal Video about Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining at JoVE.com

本研究获得国家自然科学基金（第81702406号）和广东省自然科学基金（2016A030310207）资助。

本协议遵循中山大学中山纪念医院人体研究伦理委员会的指导方针。从患者那里获得了进行这项研究的书面知情同意书。
1. 患者选择
<ol><li>选择肝脏中部恶性肿瘤患者，包括肝细胞癌 （HCC） 和肝内胆管癌 （ICC） 患者。</li>
	<li>确保这些患者没有门静脉或肝静脉受侵犯，也没有远处转移。</li>
</ol>2. 患者准备
注...

<ol>
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B., Kokudo, N., Gayet, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Positive+and+negative+staining+of+hepatic+segments+by+use+of+fluorescent+imaging+techniques+during+laparoscopic+hepatectomy.">Positive and negative staining of hepatic segments by use of fluorescent imaging techniques during laparoscopic hepatectomy.</a> Archives of Surgery. 147 (4), 393-394 (2012).</li><li>Procopio, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound-guided+anatomical+liver+resection+using+a+compression+technique+combined+with+indocyanine+green+fluorescence+imaging.">Ultrasound-guided anatomical liver resection using a compression technique combined with indocyanine green fluorescence imaging.</a> HPB. 23 (2), 206-211 (2021).</li><li>Takemura, N., Ito, K., Inagaki, F., Mihara, F., Kokudo, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Added+value+of+indocyanine+green+fluorescence+imaging+in+liver+surgery.">Added value of indocyanine green fluorescence imaging in liver surgery.</a> Hepatobiliary &amp; Pancreatic Diseases International. 21 (4), 310-317 (2022).</li><li>Maluccio, M., Covey, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recent+progress+in+understanding,+diagnosing,+and+treating+hepatocellular+carcinoma.">Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma.</a> CA: A Cancer Journal for Clinicians. 62 (6), 394-399 (2012).</li><li>Lamade, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+3-dimensional+reconstructions+on+operation+planning+in+liver+surgery.">The impact of 3-dimensional reconstructions on operation planning in liver surgery.</a> Archives of Surgery. 135 (11), 1256-1261 (2000).</li><li>Pringle, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Notes+on+the+arrest+of+hepatic+hemorrhage+due+to+trauma.">Notes on the arrest of hepatic hemorrhage due to trauma.</a> Annals of Surgery. 48 (4), 541-549 (1908).</li><li>Yamamoto, M., Ariizumi, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Glissonean+pedicle+approach+in+liver+surgery.">Glissonean pedicle approach in liver surgery.</a> Annals of Gastroenterological Surgery. 2 (2), 124-128 (2018).</li><li>Cho, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relation+between+hepatic+and+portal+veins+in+the+right+paramedian+sector:+proposal+for+anatomical+reclassification+of+the+liver.">Relation between hepatic and portal veins in the right paramedian sector: proposal for anatomical reclassification of the liver.</a> World Journal of Surgery. 28 (1), 8-12 (2004).</li><li>Shindoh, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complete+removal+of+the+tumor-bearing+portal+territory+decreases+local+tumor+recurrence+and+improves+disease-specific+survival+of+patients+with+hepatocellular+carcinoma.">Complete removal of the tumor-bearing portal territory decreases local tumor recurrence and improves disease-specific survival of patients with hepatocellular carcinoma.</a> Journal of Hepatology. 64 (3), 594-600 (2016).</li><li>Ishizawa, T., Saiura, A., Kokudo, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+application+of+indocyanine+green-fluorescence+imaging+during+hepatectomy.">Clinical application of indocyanine green-fluorescence imaging during hepatectomy.</a> Hepatobiliary Surgery and Nutrition. 5 (4), 322-328 (2016).</li><li>Nishino, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+is+a+precise+anatomic+resection+of+the+liver?+Proposal+of+a+new+evaluation+method+in+the+era+of+fluorescence+navigation+surgery.">What is a precise anatomic resection of the liver? 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P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+technique+and+outcomes+of+central+hepatectomy+by+the+Glissonian+suprahilar+approach.">The technique and outcomes of central hepatectomy by the Glissonian suprahilar approach.</a> European Journal of Surgical Oncology. 45 (12), 2369-2374 (2019).</li><li>Rotellar, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Standardized+laparoscopic+central+hepatectomy+based+on+hilar+caudal+view+and+root+approach+of+the+right+hepatic+vein.">Standardized laparoscopic central hepatectomy based on hilar caudal view and root approach of the right hepatic vein.</a> Journal of Hepato-Biliary-Pancreatic Sciences. 27 (1), 7-8 (2019).</li><li>Muttillo, E. 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解剖学肝切除术基于门静脉区域，其对肝癌的治疗效果仍在探索中。其理论依据是，肝癌沿门静脉扩散是其复发和转移的主要原因18。在20世纪，幕内首次提出解剖肝切除术，从最初的开放门静脉穿刺用亚甲蓝染色，揭示标志性的肝静脉，并已发展到目前的门静脉和腹腔镜荧光导航的术前分析5,6,7。ICG被公认为...

中央肝切除术是用于治疗位于第 4、5 和 8 节的肝脏恶性肿瘤的主要手术方法 1,2。标准中央肝切除术需要完全切除这些节段，这需要暴露矢状部分、中肝静脉 （MHV） 和右肝静脉 （RHV）3。第 4、5 和 8 段属于中央肝切除术2 的类别。
随着精准肝脏手术的进步，解剖肝切除术发展迅速。然而，准确确定肝切除切除平面的方法是一个关键点和不确定的领域。通常，根据缺血区4结扎Glisson椎弓根以划定表面边界。为了控制深平面，在横断术期间，通常在术中超声引导下使用解剖标志，包括肝静脉和门静脉分支 5。Makuuchi的方法通过在超声引导下将亚甲蓝注射到门静脉中来显示切除边缘，在取出标本后在肝切除平面上暴露重要的肝静脉5,6,7。
由于肝细胞特异性吸收吲哚菁绿 （ICG），因此其荧光清楚地显示了切除边界。青木于 2008 年首次报道了由 ICG 荧光引导的解剖肝切除术8.ICG荧光染色方法可分为阳性染色和阴性染色9。阴性染色技术在夹紧节段门静脉蒂10 后通过静脉注射 ICG 进行。然后，残余的肝脏显示荧光，但门静脉区域没有。与传统方法相比，荧光导航下的解剖肝切除术不仅可以在肝脏表面显示切除边界，还可以引导深切平面。对于半肝切除术和节段性肝切除术，建议采用阴性染色技术。迄今为止，使用荧光导航的解剖肝切除术已成为肝脏手术的流行方法11,12。本文介绍了荧光腹腔镜中央肝切除术的阴性染色技术。术前通过Child-Pugh评分系统对患者进行分类，并据此选择A级评分的患者13。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>BK Flex Focus 800</td>
			<td>BK Medical</td>
			<td>8666-RF</td>
			<td>Intraoperative ultrasound</td>
		</tr>
		<tr>
			<td>Entecavir</td>
			<td>Bristol Myers Squibb</td>
			<td>H20052237</td>
			<td>Antiviral drugs</td>
		</tr>
		<tr>
			<td>Hakko Sonoguide PTC Needle</td>
			<td>Hakko-medical</td>
			<td>&#160;PTC-B 18G/20G</td>
			<td>Portal vein puncture</td>
		</tr>
		<tr>
			<td>Indocyanine green</td>
			<td>Dandong Yichuang Pharmaceutical</td>
			<td>0902007 GH102</td>
			<td>Fluorescent dye</td>
		</tr>
		<tr>
			<td>PINPOINT Endoscopic Fluorescence Imaging System</td>
			<td>Stryker</td>
			<td>PC9000</td>
			<td>Fluorescent laparoscope</td>
		</tr>
		<tr>
			<td>Tenofovir</td>
			<td>GILEAD</td>
			<td>H20180060</td>
			<td>Antiviral drugs</td>
		</tr>
		<tr>
			<td>Trocar</td>
			<td>Ethicon Endo-Surgery</td>
			<td>B5LT/B12LT</td>
			<td>Trocar</td>
		</tr>
	</tbody>
</table>

fluorescent laparoscopic central hepatectomy for liver cancer using indocyanine green negative staining

腹腔镜肝切除术是肝癌的重要治疗方法。过去，切除边界通常由术中超声、重要的血管结构和外科医生的经验来确定。随着解剖肝切除术的发展，视觉外科技术已逐渐应用于此类手术，特别是吲哚菁绿（ICG）引导的解剖肝切除术。由于ICG可以被肝细胞特异性摄取并用于荧光示踪，因此已根据不同的肿瘤位置应用了阴性染色技术。在ICG荧光引导下，肝切除时可以更准确地显示表面边界和深切平面。因此，可以在解剖学上切除荷瘤肝段，这有助于避免对重要血管的损害，并减少剩余肝组织的缺血或充血。最后，术后胆瘘和肝功能障碍的发生率降低;因此，肝癌切除后可获得更好的预后。位于中央的肝癌通常被定义为位于第 4、5 或 8 节的肿瘤，需要切除肝脏的中间部分。这些是最难进行的肝切除术之一，因为手术伤口很大，而且有多个血管横断。根据具体的肿瘤位置，我们通过设计个性化的荧光染色策略来制定所需的切除范围。通过完成基于门静脉区域的解剖切除术，本工作旨在达到最佳的治疗效果。

2020-2022年，6例肝癌患者行荧光腹腔镜中央肝切除术。其中，4例患者接受了第4、5和8段的切除术，2例患者仅接受了第5段和第8段的切除术（表1）。没有患者转为开放手术。他们的年龄从46岁到74岁不等。肿瘤大小从 5 到 9 厘米不等。中位手术时间为 240 min，术中中位失血量为 450 mL。术后中位住院时间为7天。所有患者仍在随访中。
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Watch this Scientific Journal Video about Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining at JoVE.com

Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining

本方案描述了腹腔镜中央肝切除术中的荧光阴性染色。这种技术可以使肝切除术更加准确和精确。

荧光腹腔镜中央肝切除术使用吲哚菁绿阴性染色治疗肝癌

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ...

该协议可以准确确定解剖肝切除术的切除平面。外科医生可以在中央肝切除术的荧光引导下使用荧光技术悠闲地进行右平面切除术。术前准备后，在镰状韧带右侧一厘米处分离肝实质。使用夹子，结扎和横断 Glisson 椎弓根分支的几个节段。接下来，沿着Laennec的囊分开右前肝椎弓根，并结扎或闭塞右侧前肝椎弓根。为了确定右前切段和右后切段之间的边界，在外周注入两毫升 1 至 100 稀释的 ICG 进行阴性染色。然后，沿右侧荧光边界解剖肝实质，并在获得足够的空间后使用线性吻合器横断右侧前肝椎弓根。在根部分离肝中静脉，并使用线性吻合器将其横断。在荧光示踪下，保留右肝静脉的躯干，横断右肝静脉的V5d和V8d分支，完成标本切除。要切除第 5 节和第 8 节，请沿 Laennec 的囊分开右前肝椎弓根。进行 2 毫升 1 至 100 稀释的 ICG 的外周注射以进行阴性染色，以确定左、右前和右后切段之间的边界。然后，处理左侧切除平面，沿左侧荧光边界解剖肝实质，保留肝主静脉的躯干，并横断主肝静脉的V5v和V8v分支。获得足够的空间后，使用线性吻合器横断右前肝椎弓根。接下来，沿右侧荧光边界解剖肝实质，保留右侧肝静脉的躯干，横断右侧肝静脉的V5d和V8d分支，并完成标本切除。6例肝细胞癌患者行荧光腹腔镜中央肝切除术。其中，4例患者行了第四节、第五节、第八节段的切除术，2例患者仅行了第五节段和第八节段的切除术。显示了 6 名患者的临床参数。重要的是沿着Laennec的囊分开右前肝椎弓根，结扎或闭塞右前肝椎弓根。当荧光边界不准确时，在术中超声的帮助下和重要解剖标志（如 MHV 或 RHV）的引导下完成手术。

Research

JoVE Journal

Medicine

Detecting Abnormalities in Choroidal Vasculature in a Mouse Model of Age-related Macular Degeneration by Time-course Indocyanine Green Angiography

按时间当然吲哚菁绿血管造影检测脉络膜血管系统异常在年龄相关性黄斑变性的小鼠模型

Indocyanine Green&#160;Angiography (or ICGA) is a technique performed by ophthalmologists to diagnose abnormalities of the choroidal and retinal ...

科研

医学

Laparoscopic Technique for Serial Collection of Liver and Mesenteric Lymph Nodes in Macaques

腹腔镜技术在猕猴肝和肠系膜淋巴结的串行采集

The mesenteric lymph nodes (MLN) and the liver are exposed to microbes and microbial products from the gastrointestinal (GI) tract, making them ...

Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure

Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure

肝分型与门静脉结扎大鼠分期肝切除 (ALPPS) 手术模型的建立

Recent clinical data support an aggressive surgical approach to both primary and metastatic liver tumors. For some indications, like colorectal liver ...

Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy

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静脉大鼠部分肝移植的体内血管定向70% 肝切除术

Split liver transplantation and living liver donor liver transplantation were developed in the clinic to utilize liver organs in a more efficient manner. ...

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen

通过结合70%部分切除术和对乙酰氨基酚，生成急性肝衰竭大鼠模型

Acute liver failure (ALF) is a clinical condition caused by various etiologies resulting in the loss of metabolic, biochemical, synthesizing, and ...

Laparoscopic Radical Left Pancreatectomy for Pancreatic Cancer: Surgical Strategy and Technique Video

胰腺癌的腹腔镜根左造影切除术：手术策略与技术视频

Radical resection margins, resection of Gerota&#8217;s (perirenal) fascia, and adequate lymph node dissection are crucial for an adequate oncological ...

DUCT: Double Resin Casting followed by Micro-Computed Tomography for 3D Liver Analysis

DUCT：双树脂铸造，然后进行微型计算机断层扫描，用于3D肝脏分析

The liver is the biggest internal organ in humans and mice, and high auto-fluorescence presents a significant challenge for assessing the ...

Indocyanine Green-Guided Intraoperative Imaging to Facilitate Video-Assisted Retroperitoneal Debridement for Treating Acute Necrotizing Pancreatitis

吲哚菁绿色引导术中影像学促进视频辅助腹膜后清创治疗急性坏死性胰腺炎

Video-assisted retroperitoneal debridement (VARD) is a feasible, minimally invasive necrosectomy method for treating severe acute necrotizing ...

Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst

使用吲哚菁绿荧光成像进行机器人左肝切除术治疗肝内复合胆囊肿

Biliary cysts (BC) are rare congenital dilatations of intra- and extrahepatic parts of the biliary tract and bear a significant risk of carcinogenesis. ...

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

腹腔镜胰十二指肠切除术使用原 位 非接触式隔离技术治疗胰腺癌

Laparoscopic pancreatoduodenectomy (LPD) is a standard radical operation for pancreatic head malignant tumors by now. Due to the complex laparoscopic ...