Abstract
HCA resection is crucial to prevent bleeding and malignant transformation. The aim of this study was to enhance the precision of tumor resection in hepatocellular adenoma (HCA) through the combination of intraoperative ultrasound (IOUS) and indocyanine green (ICG) fluorescence imaging. ICG was intravenously injected 24 h before surgery, enabling positive staining of HCA nodules. IOUS guided the parenchymal transection performed using the RoboLap approach. IOUS combined with ICG effectively demarcated lesions, allowing precision surgery while sparing healthy liver tissue. Intraoperative frozen examination further validated the potential of ICG to identify previously undetected lesions. The study showed promising advantages of ICG in HCA resections, potentially reducing the risk of recurrence and malignant transformation. The combined robotic and laparoscopic approach improved the feasibility of parenchymal-sparing surgery, offering a cautious assessment of HCA lesions.
This is a preview of subscription content, log in via an institution to check access.
References
Kim SM, Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Hong SM (2021) Clinicopathological features and post-resection outcomes of hepatocellular adenoma. Ann Hepato-Biliary-Pancreatic Surg. https://doi.org/10.14701/ahbps.2021.25.1.25
Aldrighetti L, Cetta F, Ferla G (2015) Benign tumors of the liver. Springer, Cham
Pompili M, Ardito F, Brunetti E, Cabibbo G, Calliada F, Cillo U, de Sio I, Golfieri R, Grova M, Gruttadauria S, Guido M, Iavarone M, Manciulli T, Pagano D, Pettinari I, Santopaolo F, Soresi M, Colli A (2022) Benign liver lesions (2022): Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d’Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) Part II Solid lesions. Digestive and Liver Disease. https://doi.org/10.1016/j.dld.2022.08.031
Azizaddini S, Mani N (2023) Liver imaging. StatPearls Publishing, Treasure Island
Romailler É, Schmidt Kobbe S, Moradpour D, Sempoux C (2020) Adénomes hépatocellulaires: update 2020 [Hepatocellular adenoma: update 2020]. Rev Med Suisse 16(704):1554–1559
Berardi G, Colasanti M, Meniconi RL, Ferretti S, Guglielmo N, Mariano G, Burocchi M, Campanelli A, Scotti A, Pecoraro A, Angrisani M, Ferrari P, Minervini A, Gasparoli C, Wakabayashi G, Ettorre GM (2021) The applications of 3D imaging and indocyanine green dye fluorescence in laparoscopic liver surgery. Diagnostics (Basel). https://doi.org/10.3390/diagnostics11122169
Aldrighetti L, Cipriani F, Fornoni G, Catena M, Ratti F (2023) Robo-lap approach for anatomical resections of postero-superior liver segments by indocyanine green fluorescence: intraoperative navigation based on vascular landmarks. Chirurgia (Bucur). https://doi.org/10.21614/chirurgia.2816
Franz M, Arend J, Wolff S, Perrakis A, Rahimli M, Negrini VR, Stockheim J, Lorenz E, Croner R (2021) Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery - valuation of early adopters from Germany. Innov Surg Sci. https://doi.org/10.1515/iss-2020-0019
Herman P, Fonseca GM, Kruger JAP, Jeismann VB, Coelho FF (2021) Guidelines for the treatment of hepatocellular adenoma in the era of molecular biology: an experience-based surgeons’ perspective. J Gastrointest Surg. https://doi.org/10.1007/s11605-020-04724-1
Aldrighetti L, Catena M, Ratti F (2022) Maximizing performance in complex minimally invasive surgery of the liver: the robolap approach. J Gastrointest Surg. https://doi.org/10.1007/s11605-022-05340-x
Nault JC, Couchy G, Balabaud C, Morcrette G, Caruso S, Blanc JF, Bacq Y, Calderaro J, Paradis V, Ramos J, Scoazec JY, Gnemmi V, Sturm N, Guettier C, Fabre M, Savier E, Chiche L, Labrune P, Selves J, Wendum D, Pilati C, Laurent A, De Muret A, Le Bail B, Rebouissou S, Imbeaud S (2017) Molecular classification of hepatocellular adenoma associates with risk factors, bleeding, and malignant transformation. Gastroenterology. https://doi.org/10.1053/j.gastro.2016.11.042
Cipriani F, Ratti F, Aldrighetti L (2020) Laparoscopic liver resections at the gates of 2020: a stand-alone field of hepatobiliary surgery. Hepatobiliary Surg Nutr. https://doi.org/10.21037/hbsn.2019.11.07
Acknowledgements
Not applicable.
Funding
No source of funding has been received for the production of this technical note.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare that there are no competing interests.
Ethics approval
The study was approved by the institutional ethics committee and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.
Conflict of interest
The authors declare that they have no conflicts of interest.
Human participants and/or animals and Informed consent
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Supplementary file1 (MP4 203605 KB)
Rights and permissions
About this article
Cite this article
Ingallinella, S., Aldrighetti, L., Marino, R. et al. Indocyanine green (ICG)-guided robotic resection for liver adenoma: combined technologies for precision surgery. Updates Surg 76, 1105–1108 (2024). https://doi.org/10.1007/s13304-024-01840-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-024-01840-4