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Indocyanine Green Perfusion Imaging-Guided Laparoscopic Pancreaticoduodenectomy: Potential Application in Retroperitoneal Margin Dissection.

Authors
 Seoung Yoon Rho  ;  Ji Su Kim  ;  Jae Uk Chong  ;  Ho Kyoung Hwang  ;  Dong Sub Yoon  ;  Woo Jung Lee  ;  Chang Moo Kang 
Citation
 JOURNAL OF GASTROINTESTINAL SURGERY, Vol.22(8) : 1470-1474, 2018 
Journal Title
 JOURNAL OF GASTROINTESTINAL SURGERY 
ISSN
 1091-255X 
Issue Date
2018
Keywords
ICG ; Indocyanine green ; Laparoscopic pancreaticoduodenectomy ; Retroperitoneal margin
Abstract
BACKGROUND: During laparoscopic pancreaticoduodenectomy (LPD), dissecting uncinate process from the superior mesenteric artery (SMA) will determine one of the important surgical margins (retroperitoneal margin) for predicting oncological outcomes and the quality of LPD. However, clear identification of the division line for retroperitoneal margin is not easy as the uncinate process of the pancreas is anatomically very close to SMA and intermingled with the nerve plexus and soft tissues around SMA. In this study, we present data regarding the potential usefulness of indocyanine green (ICG)-enhanced approach in obtaining retroperitoneal margin during LPD. METHODS: From January to September 2017, medical records of patients who underwent LPD for periampullary pathological conditions were retrospectively reviewed. ICG (5 mg/2 cm3) was prepared and intravenously injected when dissecting uncinate process of the pancreas. Perioperative outcomes, including gender, age, diagnosis, body mass index, operation time, estimated blood loss, transfusion, presence of postoperative pancreatic fistulas (POPFs), and length of hospital stay, were evaluated. RESULTS: During the study period, a total of 37 patients underwent LPD for periampullary pathological lesions. Among them, ICG-enhanced dissection of uncinate process of the pancreas was applied in 10 patients (27%). All patients were able to obtain margin-negative resection. There were no significant differences between the perioperative outcomes of patients who did and did not undergo ICG-enhanced approach. DISCUSSION: ICG perfusion-based laparoscopic dissection of retroperitoneal margin is feasible and safe in LPD. This intraoperative visual difference can provide the surgeon with very helpful real-time visual information. Further study is mandatory.
Full Text
https://link.springer.com/article/10.1007%2Fs11605-018-3760-7
DOI
10.1007/s11605-018-3760-7
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Kim, Ji Su(김지수) ORCID logo https://orcid.org/0000-0002-9501-9665
Rho, Seoung Yoon(노승윤) ORCID logo https://orcid.org/0000-0002-1265-826X
Yoon, Dong Sup(윤동섭) ORCID logo https://orcid.org/0000-0001-6444-9606
Lee, Woo Jung(이우정) ORCID logo https://orcid.org/0000-0001-9273-261X
Hwang, Ho Kyoung(황호경) ORCID logo https://orcid.org/0000-0003-4064-7776
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/163207
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