Abstract：
BACKGROUND: Laparoscopic left hemihepatectomy (LLH) has been shown to be an effective and safe method for treating hepatolithiasis primarily affecting the left hemiliver. However, this procedure still presents challenges. Due to pathological changes in intrahepatic duct stones, safely dissecting the hilar vessels and determining precise resection boundaries remains difficult, even with fluorescent imaging. Our team proposed a new method of augmented reality navigation (ARN) combined with Indocyanine green (ICG) fluorescence imaging for LLH in hepatolithiasis cases. This study aimed to investigate the feasibility of this combined approach in the procedure.
METHODS: Between May 2021 and September 2023, 16 patients with hepatolithiasis who underwent LLH were included. All patients underwent preoperative 3D evaluation and were then guided using ARN and ICG fluorescence imaging during the procedure. Perioperative and short-term postoperative outcomes were assessed to evaluate the safety and efficacy of the method.
RESULTS: All 16 patients successfully underwent LLH. The mean operation time was 380.31 ± 92.17 min, with a mean estimated blood loss of 116.25 ± 64.49 ml. ARN successfully aided in guiding hilar vessel dissection in all patients. ICG fluorescence imaging successfully identified liver resection boundaries in 11 patients (68.8%). In the remaining 5 patients (31.3%) where fluorescence imaging failed, virtual liver segment projection (VLSP) successfully identified their resection boundaries. No major complications occurred in any patients. Immediate stone residual rate, stone recurrence rate, and stone extraction rate through the T-tube sinus tract were 12.5%, 6.3%, and 6.3%, respectively.
CONCLUSIONS: The combination of ARN and ICG fluorescence imaging enhances the safety and precision of LLH for hepatolithiasis. Moreover, ARN may serve as a safe and effective tool for identifying precise resection boundaries in cases where ICG fluorescence imaging fails.
METHODS: Between May 2021 and September 2023, 16 patients with hepatolithiasis who underwent LLH were included. All patients underwent preoperative 3D evaluation and were then guided using ARN and ICG fluorescence imaging during the procedure. Perioperative and short-term postoperative outcomes were assessed to evaluate the safety and efficacy of the method.
RESULTS: All 16 patients successfully underwent LLH. The mean operation time was 380.31 ± 92.17 min, with a mean estimated blood loss of 116.25 ± 64.49 ml. ARN successfully aided in guiding hilar vessel dissection in all patients. ICG fluorescence imaging successfully identified liver resection boundaries in 11 patients (68.8%). In the remaining 5 patients (31.3%) where fluorescence imaging failed, virtual liver segment projection (VLSP) successfully identified their resection boundaries. No major complications occurred in any patients. Immediate stone residual rate, stone recurrence rate, and stone extraction rate through the T-tube sinus tract were 12.5%, 6.3%, and 6.3%, respectively.
CONCLUSIONS: The combination of ARN and ICG fluorescence imaging enhances the safety and precision of LLH for hepatolithiasis. Moreover, ARN may serve as a safe and effective tool for identifying precise resection boundaries in cases where ICG fluorescence imaging fails.
摘要：
背景：腹腔镜左半肝切除术（LLH）已被证明是治疗主要影响左半肝的肝胆管结石的有效且安全的方法。然而,这一程序仍然存在挑战。由于肝内胆管结石的病理变化，安全解剖肺门血管并确定精确的切除边界仍然很困难，即使有荧光成像。我们的团队提出了一种新的增强现实导航（ARN）结合吲哚菁绿（ICG）荧光成像的方法，用于肝胆管结石病例的LLH。本研究旨在探讨这种联合方法在手术中的可行性。
方法：在2021年5月至2023年9月之间，纳入了16例接受LLH的肝胆管结石患者。所有患者均接受术前3D评估，然后在手术过程中使用ARN和ICG荧光成像进行指导。评估围手术期和术后短期结果，以评估该方法的安全性和有效性。
结果：所有16例患者均成功接受了LLH。平均手术时间380.31±92.17min,平均估计失血量为116.25±64.49ml。ARN成功地帮助指导所有患者的肺门血管夹层。ICG荧光成像成功识别了11例患者（68.8％）的肝切除边界。在其余5例（31.3%）荧光成像失败的患者中，虚拟肝段投影（VLSP）成功识别其切除边界。所有患者均未发生重大并发症。即时残石率,结石复发率,经T管窦道取石率为12.5%,6.3%,和6.3%，分别。
结论：ARN和ICG荧光成像的结合提高了LLH治疗肝胆管结石的安全性和准确性。此外，在ICG荧光成像失败的情况下，ARN可以作为识别精确切除边界的安全有效工具。
方法：在2021年5月至2023年9月之间，纳入了16例接受LLH的肝胆管结石患者。所有患者均接受术前3D评估，然后在手术过程中使用ARN和ICG荧光成像进行指导。评估围手术期和术后短期结果，以评估该方法的安全性和有效性。
结果：所有16例患者均成功接受了LLH。平均手术时间380.31±92.17min,平均估计失血量为116.25±64.49ml。ARN成功地帮助指导所有患者的肺门血管夹层。ICG荧光成像成功识别了11例患者（68.8％）的肝切除边界。在其余5例（31.3%）荧光成像失败的患者中，虚拟肝段投影（VLSP）成功识别其切除边界。所有患者均未发生重大并发症。即时残石率,结石复发率,经T管窦道取石率为12.5%,6.3%,和6.3%，分别。
结论：ARN和ICG荧光成像的结合提高了LLH治疗肝胆管结石的安全性和准确性。此外，在ICG荧光成像失败的情况下，ARN可以作为识别精确切除边界的安全有效工具。
