Applications of fusion-fluorescence imaging using indocyanine green in laparoscopic hepatectomy

Surg Endosc. 2017 Dec;31(12):5111-5118. doi: 10.1007/s00464-017-5576-z. Epub 2017 Apr 28.


Background: Indocyanine green (ICG)-fluorescence imaging has been developed for real-time identification of hepatic tumors and segmental boundaries during hepatectomy. Fusion ICG-fluorescence imaging (real-time visualization of pseudocolor-fluorescence signals on white-light color images) may serve as a reliable navigation tool especially in laparoscopic hepatectomy, in which gross inspection and palpation are limited.

Methods: The study population consisted of 41 patients undergoing laparoscopic hepatectomy. Hepatic tumors were identified by fluorescence imaging following the preoperative intravenous administration of ICG (0.5 mg/kg body weight). To visualize hepatic perfusion and segmental boundaries, ICG (1.25 mg) was injected intravenously during surgery, following closure of the proximal portal pedicle. A laparoscopic imaging system, which enabled superimposition of the pseudocolor-fluorescence images on white color images, was used for the fusion ICG-fluorescence imaging.

Results: Among the 53 malignant tumors resected, fusion ICG-fluorescence imaging revealed 45 nodules (85%), including three nodules of colorectal liver metastasis unidentifiable by white-light color images or intraoperative ultrasonography. It also delineated the segmental boundaries on the hepatic raw surfaces as well as on the phrenic/visceral surfaces in all 12 patients evaluated using this technique.

Conclusions: Fusion imaging enhances the feasibility of intraoperative ICG-fluorescence imaging in the identification of hepatic tumors and segmental boundaries. It may therefore help surgeons in the safe and accurate completion of laparoscopic hepatectomies.

Keywords: Colorectal liver metastasis; Fluorescence imaging; Hepatic segmentectomy; Indocyanine green; Laparoscopic hepatectomy.

Publication types

  • Video-Audio Media

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / diagnostic imaging
  • Carcinoma, Hepatocellular / surgery
  • Feasibility Studies
  • Female
  • Fluorescent Dyes*
  • Gastrointestinal Stromal Tumors / diagnostic imaging
  • Gastrointestinal Stromal Tumors / surgery
  • Hepatectomy / methods*
  • Humans
  • Indocyanine Green*
  • Laparoscopy / methods*
  • Liver Neoplasms / diagnostic imaging
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Optical Imaging / methods*


  • Fluorescent Dyes
  • Indocyanine Green