Surgery · 2026
Indocyanine green (ICG) fluorescence in minimally invasive liver resection: The Italian Society of Endoscopic Surgery (SICE) liver ICG study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Piccolo Gaetano, Barabino Matteo, Libia Annarita, Formisano Giampaolo, Benuzzi Laura, Colangelo Bianca, Giuffrida Mario, Barberis Andrea, Ceccarelli Graziano, Tebala Giovanni Domenico, Spampinato Marcello Giuseppe, Memeo Riccardo, Bianchi Paolo Pietro, SICE Liver ICG Study Group
Аннотация
BACKGROUND: Parenchymal-sparing liver resections are increasingly used for colorectal liver metastases but may increase positive surgical margin risks. Indocyanine green fluorescence imaging may improve lesion detection and provide real-time intraoperative margin assessment. This study evaluated indocyanine green fluorescence during minimally invasive parenchymal-sparing resections for colorectal liver metastases.
METHODS: The Italian Society of Endoscopic Surgery LIVER Indocyanine Green study is a multicenter, prospective cohort study including consecutive patients undergoing laparoscopic or robotic indocyanine green-guided nonanatomic wedge liver resection for colorectal liver metastases between May 2024 and December 2025. A standard 10 mg indocyanine green dose was administered the day before surgery. Intraoperative ultrasound and indocyanine green fluorescence were used for lesion localization, occult metastases detection, and real-time margin assessment.
RESULTS: Overall, 57 patients underwent minimally invasive parenchymal-sparing liver resection, and 91 colorectal liver metastases were resected. Indocyanine green fluorescence identified 71 peripheral lesions and detected 2 additional subcentimeter occult metastases. Preresection fluorescence patterns included rim, partial, and total fluorescence. After resection, 4 patterns were observed: absent residual fluorescence, rim discontinuity, residual rim, and protruding rim. Complete fluorescent rim integrity was associated with R0 resection in all cases. Conversely, R1 margins (<1 mm) occurred in resections showing rim discontinuity, residual rim, or protruding rim. When R0 resection was achieved despite altered rim integrity, histopathologic margins were narrow, ranging from 1 to 3 mm.
CONCLUSION: Indocyanine green fluorescence imaging successfully supported lesion detection and provided valuable real-time information on margin status during minimally invasive wedge liver resections for colorectal liver metastases. Fluorescent rim integrity represents a reliable intraoperative marker of R0 resection and should be further validated in standardized clinical trials.
METHODS: The Italian Society of Endoscopic Surgery LIVER Indocyanine Green study is a multicenter, prospective cohort study including consecutive patients undergoing laparoscopic or robotic indocyanine green-guided nonanatomic wedge liver resection for colorectal liver metastases between May 2024 and December 2025. A standard 10 mg indocyanine green dose was administered the day before surgery. Intraoperative ultrasound and indocyanine green fluorescence were used for lesion localization, occult metastases detection, and real-time margin assessment.
RESULTS: Overall, 57 patients underwent minimally invasive parenchymal-sparing liver resection, and 91 colorectal liver metastases were resected. Indocyanine green fluorescence identified 71 peripheral lesions and detected 2 additional subcentimeter occult metastases. Preresection fluorescence patterns included rim, partial, and total fluorescence. After resection, 4 patterns were observed: absent residual fluorescence, rim discontinuity, residual rim, and protruding rim. Complete fluorescent rim integrity was associated with R0 resection in all cases. Conversely, R1 margins (<1 mm) occurred in resections showing rim discontinuity, residual rim, or protruding rim. When R0 resection was achieved despite altered rim integrity, histopathologic margins were narrow, ranging from 1 to 3 mm.
CONCLUSION: Indocyanine green fluorescence imaging successfully supported lesion detection and provided valuable real-time information on margin status during minimally invasive wedge liver resections for colorectal liver metastases. Fluorescent rim integrity represents a reliable intraoperative marker of R0 resection and should be further validated in standardized clinical trials.