由实时荧光成像引导的胆管扇形区域的腹腔镜右半肝切除术

The regions of the liver with cholestasis caused by biliary tumors or thrombosis can be distinctly identified using indocyanine green (ICG) fluorescence imaging.1 The authors' team reported the application of bile-duct obstructed area imaging (BOAI) to assist open hepatectomy for intrahepatic cholangiocarcinoma (ICC) combined with intrahepatic bile duct obstruction previously.2 This video is the first report使用3D-4K荧光成像系统的实时BOAI引导的三维（3D）腹腔镜肝切除术。术前计算机断层扫描（CT）和磁共振cholangiopancreatography（MRCP）显示右肝管的阻塞和扩散扩张。在手术前5天进行了15分钟的ICG（ICG R15），结果为3.3％。术前计划涉及进行腹腔镜右半羊皮切除术，并通过可视化技术辅助的区域淋巴结清扫术进行术。3在手术过程中，通过荧光成像显示了右肝脏中的明显荧光积累。在实时BOAI的指导下（图1），精确切除了胆道阻塞的区域，并且肝静脉中部（MHV）被动地在切割平面上充分暴露。图1实时胆管扇形区域成像的管理步骤。在手术前3-5天注入ICG的剂量为0.5 mg/kg。注射后几分钟内，B ICG积聚在整个肝脏中。 C ICG被肝脏选择性地吸收并排出肠道，从而将其保留在胆道梗阻的区域中：组织病理学诊断表明，右胆管肿瘤的高级上皮内肿瘤无淋巴结转移酶和克罗诺氏症。手术持续时间为300分钟，术中失血为50 mL。没有发生术后并发症，并且在7天后将患者出院。在实时boai的指导下，胆汁导管的唇型右半肝切除术是可行且有效的。

The regions of the liver with cholestasis caused by biliary tumors or thrombosis can be distinctly identified using indocyanine green (ICG) fluorescence imaging.1 The authors' team reported the application of bile-duct obstructed area imaging (BOAI) to assist open hepatectomy for intrahepatic cholangiocarcinoma (ICC) combined with intrahepatic bile duct obstruction previously.2 This video is the first report of real-time BOAI-guided three-dimensional (3D) laparoscopic hepatectomy using a 3D-4K fluorescence imaging system.A 65-year-old man was admitted to the authors' institution with clonorchiasis. Preoperative computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed an obstruction and diffuse dilation of the right hepatic duct. A 15-min retention of ICG (ICG R15) was performed 5 days before the operation, with a 3.3% result. Preoperative planning involved performing laparoscopic right hemi-hepatectomy with regional lymph node dissection assisted by visualization technology.3 During the procedure, significant fluorescence accumulation in the right liver was shown by fluorescence imaging. With the guidance of real-time BOAI (Fig. 1), the regions of biliary obstruction were precisely resected, and the middle hepatic vein (MHV) was passively and adequately exposed on the cutting plane. Fig. 1 Administration steps for real-time bile duct-obstructed area imaging. A ICG is injected intravenously 3-5 days before operation at a dose of 0.5 mg/kg. B ICG is accumulated in the whole liver within a few minutes after injection. C ICG is selectively absorbed by the liver and excreted into the intestines, whereby it is retained in areas of biliary obstruction RESULTS: The histopathologic diagnosis indicated high-grade intraepithelial neoplasia of the right bile duct tumor without lymph node metastases and clonorchiasis. The duration of the operation was 300 min, with an intraoperative blood loss of 50 ml. No postoperative complications occurred, and the patient was discharged after 7 days.Laparoscopic right hemi-hepatectomy for the bile-duct obstructed area with the guidance of real-time BOAI is feasible and effective.