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Deng H, Zeng X, Hu H, Zeng N, Huang D, Wu C, Fang C, Xiang N. Laparoscopic left hemihepatectomy using augmented reality navigation plus ICG fluorescence imaging for hepatolithiasis: a retrospective single-arm cohort study (with video). Surg Endosc 2024; 38:4048-4056. [PMID: 38806956 DOI: 10.1007/s00464-024-10922-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/05/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Laparoscopic left hemihepatectomy (LLH) has been shown to be an effective and safe method for treating hepatolithiasis primarily affecting the left hemiliver. However, this procedure still presents challenges. Due to pathological changes in intrahepatic duct stones, safely dissecting the hilar vessels and determining precise resection boundaries remains difficult, even with fluorescent imaging. Our team proposed a new method of augmented reality navigation (ARN) combined with Indocyanine green (ICG) fluorescence imaging for LLH in hepatolithiasis cases. This study aimed to investigate the feasibility of this combined approach in the procedure. METHODS Between May 2021 and September 2023, 16 patients with hepatolithiasis who underwent LLH were included. All patients underwent preoperative 3D evaluation and were then guided using ARN and ICG fluorescence imaging during the procedure. Perioperative and short-term postoperative outcomes were assessed to evaluate the safety and efficacy of the method. RESULTS All 16 patients successfully underwent LLH. The mean operation time was 380.31 ± 92.17 min, with a mean estimated blood loss of 116.25 ± 64.49 ml. ARN successfully aided in guiding hilar vessel dissection in all patients. ICG fluorescence imaging successfully identified liver resection boundaries in 11 patients (68.8%). In the remaining 5 patients (31.3%) where fluorescence imaging failed, virtual liver segment projection (VLSP) successfully identified their resection boundaries. No major complications occurred in any patients. Immediate stone residual rate, stone recurrence rate, and stone extraction rate through the T-tube sinus tract were 12.5%, 6.3%, and 6.3%, respectively. CONCLUSION The combination of ARN and ICG fluorescence imaging enhances the safety and precision of LLH for hepatolithiasis. Moreover, ARN may serve as a safe and effective tool for identifying precise resection boundaries in cases where ICG fluorescence imaging fails.
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Affiliation(s)
- Haowen Deng
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510280, China
| | - Xiaojun Zeng
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510280, China
| | - Haoyu Hu
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510280, China
| | - Ning Zeng
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510280, China
| | - Dongqing Huang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510280, China
| | - Chao Wu
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510280, China
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510280, China
| | - Nan Xiang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510280, China.
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Wang D, Hu H, Zhang Y, Wu X, Zeng X, Yang J, Fang C. Efficacy of Augmented Reality Combined with Indocyanine Green Fluorescence Imaging Guided Laparoscopic Segmentectomy for Hepatocellular Carcinoma. J Am Coll Surg 2024; 238:321-330. [PMID: 37991244 DOI: 10.1097/xcs.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND The internal anatomy of the liver is extremely complex. Laparoscopic anatomical segmentectomy requires reference to the position and alignment of intrahepatic vascular. However, the surface of the liver lacks anatomical landmarks and the liver segment boundaries cannot be identified with the naked eye. Augmented reality navigation (ARN) and indocyanine green fluorescence imaging (FI) are emerging navigation tools in liver resection. This study aimed to explore the efficacy and application value of laparoscopic anatomical segmentectomy guided by ARN combined with indocyanine green FI. STUDY DESIGN Ninety-eight patients who were diagnosed with hepatocellular carcinoma and underwent laparoscopic anatomical segmentectomy from January 2018 to January 2022 were retrospectively analyzed. They were divided into the ARN-FI group (45 patients) and the non-ARN-FI group (53 patients) based on whether ARN combined with FI was applied during the operation. The differences in intraoperative and postoperative outcomes were compared. RESULTS There was no significant difference in preoperative baseline data and postoperative complication rates between the 2 groups. Compared with the non-ARN-FI group, the ARN-FI group had much lower intraoperative blood loss (100 vs 200 mL, p = 0.005) and a lower incidence of remnant liver ischemia (13.3% vs 30.2%, p = 0.046). The 1- and 3-year disease-free survival rates in the ARN-FI and non-ARN-FI groups were 91.01% vs 71.15% and 70.01% vs 52.46%, respectively; the differences between the 2 groups were statistically significant (p = 0.047). CONCLUSIONS The ARN-FI technology provides a more standardized approach for liver parenchyma section during laparoscopic liver resection, effectively minimizing intraoperative blood loss, reducing postoperative remnant liver ischemia, and improving oncological prognosis. This method is safe and feasible and has good clinical application prospects.
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Affiliation(s)
- Dehui Wang
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Haoyu Hu
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Yuwei Zhang
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Xiwen Wu
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Xiaojun Zeng
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Jian Yang
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Chihua Fang
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
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Hu Z, Wei X. A commentary on 'Augmented reality-assisted navigation system contributes to better intraoperative and short-time outcomes of laparoscopic pancreaticoduodenectomy: a retrospective cohort study'. Int J Surg 2024; 110:1327-1328. [PMID: 38016134 PMCID: PMC10871578 DOI: 10.1097/js9.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Affiliation(s)
| | - Xiaoping Wei
- Department of HPB Surgery, The Second Affiliated Hospital of Kunming Medical University, The Second Clinical College at Kunming Medical University, Kunming, Yunnan, People’s Republic of China
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