Real-time navigation surgery for T2 gallbladder cancer using ICG fluorescence imaging

Abstract

T2 gallbladder cancer can be cured with appropriate surgery. However, a clinical trial conducted in Japan found no significant difference in prognosis between extended cholecystectomy and segment 4b+5 resection, and therefore surgical procedures have not yet been standardized. We believe that the optimal area of liver resection for resecting micrometastases is hepatic lesions perfused by the cholecystic vein, and we practice a surgical procedure in which we visualize and resect the area using indocyanine green (ICG) fluorescence.

The advent of Medical imaging projection system (MIPS) in open surgery and laparoscopic cameras equipped with full-color overlay functionality has made ICG fluorescence real-time navigation possible. In open surgery, ICG is administered via the cystic artery, but because cannulation of the cystic artery under laparoscopy is difficult, a similar procedure can be performed by administering ICG intravenously while occluding blood flow to the hepatic hilum, excluding the cystic artery.

Chiba et al. have reported a case in which this surgical procedure was used to resect micrometastases in areas that would not be resected using conventional methods. Its usefulness needs to be verified in future prospective studies.