Simultaneous tumor identification,cholangiography, and securing surgical margin for recurrence of hepatocellular carcinoma using the Medical Imaging Projection System |
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| Institution: | 1. University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany;2. University Hospital Cologne, Department of Orthopaedics, Cologne, Germany;3. Emergency Department, University Hospital of Nancy, Nancy, France;4. Center for Resuscitation Medicine, University of Minnesota, Minneapolis, USA;1. Albany Medical College, 43 New Scotland Avenue, Albany, NY, 12208, USA;2. Albany Medical College, Department of Surgery, 50 New Scotland Avenue, Albany, NY, 12208, USA;1. University of Maryland Medical Center, Department of General Surgery, USA;2. University of Maryland Baltimore, Department of Pharmaceutical Health Services Research, USA;3. University of Maryland Medical Center, Department of Gastroenterology, USA;4. Maryland Surgery, Pharmacy, and Anesthesiology Research Collaborative, USA;1. Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy;4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;5. Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;6. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy;7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;8. Department of Urology, Weill Cornell Medical College, New York, NY, USA;9. Department of Urology, University of Texas Southwestern, Dallas, TX, USA;10. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan;11. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany;12. Department of Urology, Koc University Hospital, Istanbul, Turkey;13. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy;1. Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain;2. Department of Obstetrics and Gynecology, Hospital Virgen de los Lirios, Alcoy, Spain;3. CEU Cardenal Herrera, Valencia, Spain;4. Department of Radiology, University Hospital La Fe, Valencia, Spain;5. Department of Applied Mathematics and Statistics CEU San Pablo University, Madrid, Spain |
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| Abstract: | BackgroundIndocyanine green (ICG) fluorescence-guided surgery is a real-time navigation technology for tumor detection, securing surgical margins, segmentation mapping, and cholangiography in liver surgery 1]. According to recent reports, the Medical Imaging Projection System (MIPS) may be a useful new real-time navigation technology for open anatomical liver resection 2]. However, the efficacy of MIPS for tumor identification, cholangiography, and securing surgical margins is uncertain. In this report, we introduce MIPS-assisted liver resection for real-time navigation during simultaneous tumor identification, cholangiography, and securing surgical margins.MethodsA 76-year-old man presented with a 30 × 30 mm recurrent hepatocellular carcinoma on the transection plane after right anterior sectionectomy. Eight radiofrequency ablations were performed after the first hepatectomy. Preoperative computed tomography and three-dimensional simulation revealed a tumor near the posterior Glissonean branch. One day before surgery, 2.5 mg/body ICG was administered. We analyzed whether MIPS could simultaneously facilitate tumor identification, cholangiography, and securing surgical margins. The relationship between fluorescent imaging and the surgical margin was evaluated with a fluorescent microscope 3].ResultsSimultaneous tumor identification, cholangiography, and securing the surgical margins were demonstrated by adjusting the image projection of MIPS, and R0 resection was achieved without biliary injury (Figs. 1 and 2). The operative time and estimated blood loss were 287 minutes and 394 mL, respectively. He was discharged on postoperative day 12 without any complications.ConclusionMIPS could be useful for real-time navigation for tumor identification, cholangiography, and securing surgical margins during liver surgery. The threshold of fluorescent intensity should be set for optimal image projection. |
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| Keywords: | ICG fluorescence-Guided surgery Medical imaging projection system MIPS Cholangiography Surgical margin Recurrence Tumor identification |
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