Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2020; 12(12): 1407-1415
Published online Dec 15, 2020. doi: 10.4251/wjgo.v12.i12.1407
Robotic resection of liver focal nodal hyperplasia guided by indocyanine green fluorescence imaging: A preliminary analysis of 23 cases
Cheng-Gang Li, Zhi-Peng Zhou, Xiang-Long Tan, Zi-Zheng Wang, Qu Liu, Zhi-Ming Zhao
Cheng-Gang Li, Zhi-Peng Zhou, Xiang-Long Tan, Zi-Zheng Wang, Qu Liu, Zhi-Ming Zhao, Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Li CG and Zhou ZP contributed equally to this work and should be considered as co-first authors; Li CG and Zhou ZP analyzed and interpreted the data and wrote the manuscript; Tan XL, Wang ZZ, and Liu Q drafted the work and collected the data; Zhao ZM designed the study and revised the manuscript for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Chinese PLA General Hospital.
Informed consent statement: All patients involved in the present study provided informed written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Gang Li, MD, PhD, Associate Professor, Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. lcgang301@126.com
Received: August 17, 2020
Peer-review started: August 17, 2020
First decision: September 21, 2020
Revised: September 28, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 15, 2020
Abstract
BACKGROUND

Focal nodal hyperplasia (FNH) is a common benign tumor of the liver. It occurs mostly in people aged 40-50 years and 90% of the patients are female. FNH can be cured by local resection. How to locate and judge the tumor boundary in real time is often a challenge for surgeons.

AIM

To summarize the technique and feasibility of robotic resection of FNH guided by indocyanine green (ICG) fluorescence imaging.

METHODS

The demographics and perioperative outcomes of a consecutive series of patients who underwent robotic resection of liver FNH guided by ICG fluorescence imaging between May 1, 2018 and September 30, 2019 were retrospectively analyzed. ICG was injected through the median elbow vein in all the patients at a dose of 0.25 mg/kg 48 h before the operation. During the operation, the position of FNH in the liver was located in the fluorescence mode of the Da Vinci Si robot operating system and the tumor boundary was determined during the resection.

RESULTS

Among the 23 patients, there were 11 males and 12 females, with a mean age of 30.5 ± 9.3 years. Twenty-two cases completed robotic resection, while one (4.3%) case converted to open surgery. In the robotic surgery group, the operation time was 35-340 min with a median of 120 min, the intraoperative bleeding was 10-800 mL with a median of 50 mL, and the postoperative hospital stay was 1-7 d with a median of 4 d. Biliary fistula occurred in two (8.7%) patients after robotic operation and they both recovered after conservative treatment. One (4.3%) patient received blood transfusion and there was no death in this study. The postoperative hospital stay in the small tumor group was significantly shorter than that in the large tumor group (P < 0.05).

CONCLUSION

ICG fluorescence imaging can guide the surgeon to perform robotic resection of liver FNH by locating the tumor and displaying the tumor boundary in real time. It is a safe and feasible method to ensure the complete resection of the tumor.

Keywords: Robotic surgery, Indocyanine green, Focal nodal hyperplasia, Hepatectomy

Core Tip: Focal nodal hyperplasia (FNH) is a common benign tumor of the liver, which can be cured by local resection. The purpose of this study was to summarize the technique and feasibility of robotic resection of FNH guided by indocyanine green fluorescence imaging.