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Updated: Jul 1, 2025

The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation
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Intraoperative indocyanine green fluorescence imaging to predict early hepatic arterial complications after liver

Muga Terasawa1,2, Hiroshi Imamura2, Marc Antoine Allard1,3

  • 1Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|March 11, 2024
PubMed
Summary

A new intraoperative method using indocyanine green dye can predict early hepatic artery complications after liver transplantation. This technique helps identify high-risk patients, potentially preventing graft loss.

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Area of Science:

  • Transplantation Surgery
  • Hepatobiliary Surgery
  • Vascular Surgery

Background:

  • Early hepatic arterial occlusion (EHAO) is a severe complication following liver transplantation.
  • Standard Doppler ultrasound may not always detect subtle arterial abnormalities.
  • Timely intervention is crucial to prevent graft failure.

Purpose of the Study:

  • To introduce an innovative intraoperative criterion for assessing hepatic arterial flow abnormality.
  • To identify patients at risk for early hepatic arterial occlusion (thrombosis or stenosis).
  • To potentially guide decisions for re-anastomosis.

Main Methods:

  • Indocyanine green (ICG) dye was injected intraoperatively (0.01 mg/Kg) in 89 liver transplant recipients.
  • Fluorescence signal at the graft pedicle was quantified using ImageJ software.
  • Fluorescence intensity curves were analyzed for correlations with EHAO.

Main Results:

  • Early hepatic arterial occlusion occurred in 7.8% of patients (3 thrombosis, 4 stenosis).
  • The ratio of peak to plateau fluorescence intensity and a jagged wave pattern at the plateau phase were significant predictors of EHAO.
  • A composite parameter (ratio > 0.275 and jagged wave) showed high sensitivity and specificity for predicting EHAO and thrombosis.

Conclusions:

  • Indocyanine green fluorescence imaging provides a promising additional intraoperative tool for EHAO risk assessment.
  • This method can assist surgeons in identifying high-risk recipients, even with normal Doppler ultrasound findings.
  • Early detection can facilitate timely re-anastomosis and improve transplant outcomes.