Indocyanine green fluorescence perfusion testing in robot-assisted hepatic arterial infusion pump placement

Roderick W.J.J. van Dorst, Britte H.E.A. Ten Haaft, Stijn Franssen, Inne H.M. Borel Rinkes, Bas Groot Koerkamp, Rutger Jan Swijnenburg, Jeroen Hagendoorn*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Hepatic arterial infusion pump (HAIP) treatment is a technique used to treat liver localized malignancy with intra-arterial chemotherapy. Methylene blue is generally administered to verify hepatic perfusion and exclude inadvertent extrahepatic perfusion. The use of indocyanine green dye (ICG) combined with near-infrared (NIR) fluorescence imaging during robot-assisted HAIP placement may be an attractive alternative by providing high contrast without blue discoloration of the operative field. Methods: Data was collected retrospectively from 2 centers in the Netherlands. Intraoperative perfusion of the liver segments and extrahepatic perfusion were assessed using ICG/NIR as well as methylene blue on video imaging and correlated to postoperative 99 m-Tc perfusion scintigraphy. Results: 13 patients underwent robot-assisted surgery for HAIP placement; median length of stay was 4 days, complications occurred in 4 patients. Hepatic perfusion showed identical patterns when ICG was compared with methylene blue. In 1 patient, additional extrahepatic perfusion was found using ICG, leading to further vessel ligation. Intraoperative ICG perfusion was concordant with 99 m-Tc perfusion scintigraphy. Discussion: Liver and extrahepatic perfusion determined by ICG fluorescence imaging is concordant with blue dye perfusion and 99 m-Tc perfusion scintigraphy. Therefore, ICG fluorescence imaging is deemed a safe and reliable technique for perfusion testing during robot-assisted HAIP placement. Graphical abstract: (Figure presented.)

Original languageEnglish
Pages (from-to)5108-5113
Number of pages6
JournalSurgical endoscopy
Volume38
Issue number9
Early online date17 Jul 2024
DOIs
Publication statusPublished - Sept 2024

Keywords

  • Chemotherapy
  • Fluorescence
  • Robot-assisted surgery

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