Related Experiment Video
Updated: Aug 24, 2025
Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining
Published on: March 17, 2023
Indocyanine Green as a Navigational Adjunct for Laparoscopic Ablation of Liver Tumors
David A Gerber1,2, Jennifer S Vonderau1, Yoshiko Iwai1
1Division of Transplantation, Department of Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
Background:
Minimally invasive operative approaches for resection and thermal ablation (eg, microwave, radiofrequency) of hepatocellular carcinoma (HCC) have been successfully implemented over the last two decades, although identifying tumors can be challenging. Successfully performing laparoscopic ablation requires real-time visualization and ultrasonography skills for direct placement of the ablation probe.
Methods:
In this study, we introduce a novel adjunct to ultrasound imaging for tumors located near or on the surface of the liver via intravenous delivery of indocyanine green (ICG) dye. Non-resectable lesion(s) not amenable to percutaneous ablation were considered for laparoscopic microwave ablation. Each patient initially received a dose of .3125 mg ICG via peripheral IV.
Results:
A total of 17 patients were included. There was brisk uptake of ICG throughout the liver parenchyma in under 2 minutes in 15 of 17 patients; the remaining 2 required a second dose of ICG. In 14 cases, a hypo-fluorescent perfusion pattern in the tumor was clearly identified.
Discussion:
Integrating ICG and fluorescent imaging provides a complementary adjunct to ultrasound in identifying HCC nodules. While previous applications of ICG typically require injections several days prior to surgery or segmental injections, this study demonstrates a novel real-time application of ICG to aid surgeons with various experiences in laparoscopic-assisted ablation procedures for HCC.
