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Updated: Aug 16, 2026
Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining
Published on: March 17, 2023
Decision for preservation or ligation of aberrant left hepatic artery using fluorescence imaging in minimally
Ji Eun Jung1, Shiyeol Jun1, Seyeol Oh2
1Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Background:
In radical gastrectomy, preservation of the aberrant left hepatic artery (ALHA) should balance oncologic safety and liver-related complications. This study aimed to develop an algorithm to determine ALHA preservation or ligation using near-infrared fluorescence imaging of liver perfusion during surgery.
Methods:
This multicenter, prospective, nonrandomized comparative study included 50 patients undergoing minimally invasive gastrectomy for gastric cancer. During surgery, indocyanine green (ICG) was injected intravenously after temporarily clamping the ALHA, and liver perfusion of the left hepatic lobe was assessed based on fluorescence imaging. Patients were categorized into 3 groups based on the extent of the fluorescence defect: no Perfusion (NP), partial perfusion (PP), and complete perfusion (CP). The ALHA was preserved in the NP group and ligated in the PP and CP groups. Postoperative liver dysfunction was evaluated by monitoring changes in liver enzyme levels.
Results:
Between December 2021 and June 2023, 50 patients were enrolled: 15 in the NP group, 12 in the PP group, and 23 in the CP group. No ICG injection-related adverse events were reported. A significant increase in liver enzyme levels was observed in the PP group. Specifically, aspartate transaminase changes differed significantly among the NP, PP, and CP groups on postoperative day (POD) 1 (95.95 ± 104.5%, 303.73 ± 383.4%, and 109.39 ± 99.6%; P =.049) and POD 5 (-12.43 ± 31.1%, 7.63 ± 16.5%, and -19.51 ± 22.1%; P =.037). Alanine transaminase changes also differed on POD 3 (27.73 ± 58.5%, 313.68 ± 417.1%, and 127.68 ± 176.9%; P =.036) and POD 5 (8.19 ± 52.9%, 185.47 ± 148.3%, and 32.43 ± 77.1%; P =.004). All liver enzyme levels normalized within 5 days postoperatively, and no severe liver-related complications were observed up to 1 month after surgery. Although ALHA diameter differed among the perfusion groups, the ALHA subtype distribution was similar across the groups.
Conclusion:
Real-time near-infrared fluorescence imaging safely guided ALHA management during gastrectomy by evaluating hepatic perfusion and minimizing the risk of liver dysfunction. However, further studies are required to evaluate the safety of ALHA ligation across all perfusion patterns.
