Identification of ischaemic region and veno occlusive region using ICG imaging technique

Published: 06/14/2017

Real-time identification of ischaemic region and veno-occlusive region using the indocyanine green (ICG) imaging technique. After clamping the root of the left and middle (MHV) hepatic veins, and ligating the left portal vein and left hepatic artery, ICG (2·5 µg per ml of total liver) was injected intravenously, and the liver surface observed for 300 s. The fluorescence intensity on the liver surface increased gradually and then provided a clear demarcation of non-veno-occlusive regions corresponding to the right hepatic vein territories, veno-occlusive regions corresponding to the clamped MHV territories, and ischaemic regions corresponding to ligated left portal vein territories. The border between each region was marked using electrocautery. After extended left hepatectomy with MHV excision, fluorescence imaging visualized veno-occlusive regions, whereas they were unidentifiable on gross appearance. From: Liver transection using indocyanine green fluorescence imaging and hepatic vein clamping (Br J Surg 2017; 104: 898–906, http://onlinelibrary.wiley.com/doi/10.1002/bjs.10499/abstract)