ObjectiveTo investigate the anatomical characteristics of breast lymphatic drainage in patients with breast cancer after injecting methylene blue and indocyanine green (ICG) into the intradermis of the areola.MethodsOne hundred and eighty-six patients with stage 0–Ⅱ breast cancer were collected. The sentinel lymph node (SLN) biopsy was performed by injecting methylene blue and ICG. At the same time, the number of sentinel lymphatic channel (SLC), origin angle, direction, and consistency were also studied.ResultsA total of 308 SLCs were successfully showed in the 186 patients and 679 SLNs were detected. The 95.8% (295/308) of SLCs and 93.1% (632/679) of SLNs were showed by combination in the methylene blue and ICG. The 46.8% (87/186) of patients had 1 SLC, the 40.9% (76/186) of patients had 2 SLCs, the 12.4% (23/186) of patients had 3 SLCs. The 82.8% (255/308) of SLCs flowed from the outer upper edge of the areola, the 3.2% (10/308) of SLCs flowed from the outer lower edge of the areola, the 14.0% (43/308) of SLCs flowed from the inner upper edge of the areola. The 89.9% (277/308) of the SLCs flowed mainly through the 0°—60° interval in the outer upper quadrant, 10.1% (31/308) of the SLCs flowed through the 61°—90° interval in the outer upper quadrant.ConclusionsThe consistency of SLC and SLN stained by the two tracers is good. The number of SLC is 1–3. The SLCs flow mainly through the 0°—60° interval in the outer upper quadrant of the breast, then flow into in the axilla and don’t flow into the internal mammary lymph nodes. The deep superficial lymphatic channels under the skin and the penetrating lymphatic channels can not be showed by ICG, but the SLN can be showed by it.
Objective To explore the accuracy and efficiency of indocyanine green fluorescence (ICGF) imaging in evaluating blood perfusion of parathyroid gland (PG) during total thyroidectomy. Methods Seventy patients who underwent total thyroidectomy and bilateral central lymph node dissection for papillary thyroid carcinoma (PTC) from March 2021 to December 2021 were enrolled and randomly divided into experimental group (ICGF imaging, n=35) and control group (normal treatment, n=35). Blood perfusion of PGs was evaluated by ICGF imaging and naked eye in each group respectively. The perfusion of PGs, incidence of hypoparathyroidism, and number of autotransplanted PGs were analyzed between the two groups. Results There was no difference between two groups in the incidence of transient hypoparathyroidism (P=0.339), and no one occurred permanent hypoparathyroidism. More PGs were autotransplanted in the experimental group compared to the control group (P＜0.001). At least one PG with good perfusion in the experimental group predicted an extremely high rate of normal parathyroid hormone levels of the patients postoperatively than the control group (P=0.003). Conclusion ICGF imaging can evaluate the blood perfusion of PGs accurately and guide their autotransplantation.
ObjectiveTo understand the authors, countries/regions, institutions, journals and hot topics about the application research of indocyanine green (ICG) in hepatobiliary surgery. MethodsThis study conducted a bibliometric analysis of the literatures on the application of ICG in hepatobiliary surgery in the Web of Science Core Collection from 2008 to 2024. CiteSpace software was used to evaluate and visualize collaborative networks and hot topics. ResultsA total of 2 267 literatures were included in this study, with a citation frequency of 50 463 times. The literatures from Japan accounted for the highest proportion, and most of the papers (13.50%) were published by Kokudo N. In China, Tian Jie had published the largest number of papers (33 articles). The research hotspots focused on liver resection, bile duct surgery, liver transplantation, and tumors, with recent hotspots including “liver preservation” and “rejection” frequently appearing. ConclusionThis study aims to present the overall state and trend of the application research of ICG in hepatobiliary surgery through data capture and induction, and providing valuable references for clinicians and researchers.
ObjectiveTo summarize the application status and progress of indocyanine green fluorescence imaging in laparoscopic anatomic liver resection , and to analyze its advantages, limitations, and prospects.MethodThe literatures about indocyanine green fluorescence imaging in laparoscopic anatomic liver resection were reviewed.ResultsIndocyanine green fluorescence imaging had been preliminarily used in the operation of liver tumors and had shown its unique value in the anatomical liver resection, providing a new way to reduce the recurrence of liver cancer, improve the therapeutic effect, and prolong the survival time of patients.ConclusionsThe clinical application of indocyanine green fluorescence imaging in anatomic liver resection is still at the stage of development and popularization. Although it has unique advantages and development potential, it needs to be further improved in the aspects of tissue penetration, specificity, and staining success rate.
ObjectiveTo evaluate efficacy and safety of laparoscopic Glissonean pedicle transection anatomic hepatectomy using indocyanine green (ICG) fluorescence imaging.MethodThe retrospective analysis was made on the preoperative clinical data, surgical treatment and postoperative status of a patient with hepatocellular carcinoma who underwent the laparoscopic Glissonean pedicle transection anatomic hepatectomy using the ICG fluorescence imaging technology in the Department of Liver Surgery, West China Hospital of Sichuan University.ResultsAccording to the preoperative history, imaging and laboratory examinations, the diagnosis of hepatocellular carcinoma was considered. The intraoperative exploration revealed that there was only one tumor located in the segment Ⅳ and was superficial. The ICG fluorescence imaging was used to perform the Glissonean pedicle transection anatomic hepatectomy. The postoperative pathological diagnosis was consistent with hepatocellular carcinoma without serious complications. The patient recovered well. No recurrence was found in the follow-up period up to 6 months.ConclusionsLaparoscopic Glissonean pedicle transection anatomic hepatectomy using ICG fluorescence technology can be used as a safe and precise treatment to solve problems such as bleeding during operation, difficult determination of tumor boundary, and whether having residual tumor in surgical margin.
ObjectiveTo investigate the utility of indocyanine green angiography in flap reconstructive surgery and possibility of decrease the complications. MethodsIndocyanine green angiography was performed on 14 patients undergoing flap reconstructive surgery between February and December 2014 to evaluate the blood perfusion of the flap and to adjust the operation plan. Of 14 cases, 2 were male and 12 were female, aged 23-58 years (mean, 35.5 years); 11 flaps were used for breast reconstruction [including 3 free deep inferior epigastric antery perforator (DIEP) flaps, 4 pedicled transverse rectus abdominis myocutaneous flaps (TRAM), 2 pedicled TRAM and free TRAM, and 2 pedicled latissimus dorsi myocutaneous flaps and prosthesis], 1 pedicled latissimus dorsi myocutaneous flap for repairing chest wall defect, 1 pedicled profunda artery perforator (PAP) flap for upper leg defect, and 1 pedicled descending genicular artery perforator flap for knee defect. The size of the flaps ranged from 9 cm×6 cm to 26 cm×12 cm. ResultsA total of 32 indocyanine green angiography were performed. There was no adverse reactions to the infusion of indocyanine green. The surgery management was adjusted according to results of indocyanine green angiography findings in 5 of 14 cases. The distal part of flap were discarded because of poor perfusion in 3 cases (1 DIEP flap, 1 TRAM, and 1 PAP flap) and the other 2 cases (pedicled TRAM) needed additional free anastomosis to ensure sufficient blood supply (pedicled TRAM and free TRAM); the other flaps were harvested according to preoperative plan and repaired defect successfully. The mean follow-up was 5 months (range, 1-9 months). The other flaps survived without infection or fat necrosis except 1 PAP flap with distal necrosis. ConclusionIntraoperative indocyanine green angiography can provide real-time information of flap perfusion and then the operation plan can be adjusted in time to ensure the flap survival.
ObjectiveTo investigate the safety and feasibility of fluorescent guided laparoscopic central hepatic tumor resection via anterior transhepatic approach. MethodWe retrospectively analyzed the clinical data of three patients who underwent fluorescent guided laparoscopic central hepatic tumor resection via anterior transhepatic approach in Department of Hepatobiliary and Pancreas Minimally Invasive Surgery of Hunan Provincial People’s Hospital from April 2017 to April 2020.ResultsAll the three patients completed the operation pure laparoscopically. Pathology results showed one case of hepatocellular carcinoma and two cases of focal nodular hyperplasia, the tumor size range from 4–7 cm. The operation time was 240–320 min, and the blood loss was 150–500 mL. There was no intraoperative blood transfusion. The postoperative hospital stay was 10–30 days. Postoperative bile leakage occurred in one patient, which was cured by laparoscopic hepatectomy. Three patients were followed up for 8, 36, and 25 months, respectively, and all the patients survived and there was no tumor recurrence up to november 2020.ConclusionsLaparoscopic resection of central hepatic tumor is difficult and risky. Anterior transhepatic approach can maximize the preservation of liver parenchyma. In hepatobiliary and pancreatic centers with high volume of laparoscopic hepatectomy, this method is safe and feasible after strict patient selection, accurate preoperative evaluation, and fine intraoperative skills. Indocyanine green fluorescence navigation technology is helpful to accurately locate tumor during operation.
Indocyanine green fluorescence imaging has been widely used in hepatobiliary surgery, which can guide accurate hepatectomy and improve the prognosis of patients. Lipiodol–indocyanine green emulsion as a pure physical way to prepare lipiodol-drug mixed solvent can be used for primary interventional embolization and subsequent fluorescence-guided hepatectomy. In this paper, the application of iodized oil-indocyanine green emulsion in hepatectomy was summarized by reviewing relevant research progress at home and abroad, and further discussion and prospect were made.