Application Research of Indocyanine Green Fluorescence in Laparoscopic Hepatectomy for Liver Tumors

Application Research of Indocyanine Green Fluorescence in Laparoscopic Hepatectomy for Liver Tumors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application Research of Indocyanine Green Fluorescence in Laparoscopic Hepatectomy for Liver Tumors Xiao-jie Jiang, Ke-hao Huang, Chang-xi Liao, Wei Lin, Jian-xin Yang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7033412/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective :The study aims to discuss the advantages of using indocyanine green(ICG)fluorescence real-time navigation in laparoscopic liver tumor resection. Method :A retrospective study conducted from July 2021 to July 2023 involving 128 patients who underwent laparoscopic liver cancer resection at the Affiliated Hospital of Putian University,of which 73 patients received conventional laparoscopic surgery(non-fluorescence group)and 55 patients underwent laparoscopic surgery guided by ICG navigation(fluorescence group).The differences between the two groups of data were analyzed. Results :In terms of surgical margin,the surgical margin was negative in the fluorescence group(55 cases),and 1 case was positive in the non-fluorescence group(1/73).There was no capsule destruction in the fluorescence group,and there were 3 cases of capsule destruction in the non-fluorescence group(3/73).Abnormal nodules were found in 6 cases(6/55)in the fluorescence group,and 3 cases were positive by pathological diagnosis.From the point of view of metastasis and recurrence rate at 1 year after operation,the recurrence and metastasis rate of the fluorescence group was 7.27%,and the recurrence and metastasis rate of the non-fluorescence group was 10.96%.Compared with the two groups of data,the recurrence and metastasis rate of the fluorescence group had a decreasing trend.Compared with the non-fluorescence group,the amount of bleeding in the fluorescence group was significantly reduced(P < 0.05),and the incidence of bile leakage was reduced(P < 0.05).The above data were statistically significant.Under the near-infrared light camera,the highly differentiated tumors showed complete fluorescence,the moderately differentiated tumors showed partial fluorescence,and the poorly differentiated tumors showed ring fluorescence. Conclusion :The surgical margin can be better determined under the real-time fluorescence navigation of ICG,and the fluorescence type is related to the degree of tumor differentiation.It can effectively reduce the amount of bleeding during operation.Micronodules that are difficult to find by preoperative imaging examination can be found during the operation.It can also facilitate the identification of bile ducts during surgery and reduce the incidence of bile leakage. Laparoscopic ICG liver tumor Figures Figure 1 Introduction At present,hepatocellular carcinoma is one of the most common malignant tumors,and surgical treatment is the most important treatment. [1] Since the first laparoscopic hepatectomy was carried out in 1992,the minimally invasive surgery of laparoscopic hepatectomy has been rapidly developed. [2] However,laparoscopic surgery has the disadvantage of being unable to palpate,and it is difficult to locate the specific location and boundary of the tumor during the operation,resulting in prolonged operation time,and may even lead to serious consequences such as yaw of the surgical path and entering the tumor.Therefore,hepatobiliary surgeons are constantly exploring how to improve the efficacy of minimally invasive surgery while pursuing minimally invasive surgery. [3] In 2009,Ishizawa et al.first applied ICG fluorescence imaging technology to liver resection surgery. [4] [5] [6] The research and application of ICG fluorescence imaging technology in precise resection of liver tumors have been continuously improved.This study retrospectively analyzed the patients who underwent laparoscopic liver tumor resection using ICG navigation technology in our hospital,and explored the value of ICG navigation technology in laparoscopic liver tumor resection. [7] [8] PATIENTS AND METHODS Patients This study was approved by the Review Committee of the Affiliated Hospital of Putian University.A total of 128 patients with hepatocellular carcinoma were enrolled in the Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Hospital of Putian University from July 2021 to July 2023.Among them,73 patients underwent conventional laparoscopic liver tumor resection(non-fluorescence group)and 55 patients underwent laparoscopic liver tumor resection under ICG navigation(fluorescence group). Methods Fifty-five patients met the recommendation 3 in the consensus guidelines for the application of fluorescence imaging in hepatobiliary surgery.ICG 0.5mg/kg was injected intravenously 48-72 hours before operation.Informed consent of patients and their families was obtained before injection of ICG.The near-infrared light camera was used to detect the fluorescence intensity of ICG during the operation.Under the fluorescence imaging of ICG,the edge of the liver tumor was marked with an electric knife,and tiny nodules that were difficult to be found by preoperative imaging examination could also be observed.After liver tumor resection,the ICG fluorescence effect was used to check the surgical margin plane of the liver to check whether the resection was clean. Specimen pathological examination All specimens were diagnosed by two experienced pathologists.The degree of tumor differentiation,the nature of the cutting edge,the width of the cutting edge,and the vascular tumor thrombus were analyzed. Statistical analysis Quantitative data were expressed as mean±standard deviation.Chi-square test and t test were used for qualitative data and quantitative data respectively.If P<0.05,it was considered statistically significant.SPSS 29.0 software was used for statistical analysis. Results The clinical characteristics of 73 patients undergoing conventional laparoscopic liver tumor resection(non-fluorescence group)and 55 patients undergoing laparoscopic liver tumor resection under ICG navigation(fluorescence group)are shown in Table 1. Table 1. clinical characteristics of 73 patients Not-using ICG Using ICG Gender(n) Male 52 37 Female 21 18 Age(mean±SD/year) 60.0±12.1 64.2±13.6 HBsAg(n) Positive 57 46 Negative 16 9 Live cirrhosis(n) Positive 45 41 Negative 28 14 Surgical procedure (n) Anatomical resection 26 26 Nonanatomical resection 47 29 Blood loss (mean±SD/L) 0.32±0.36 0.18±0.19 Blood replacement (mean±SD/L) 0±0 0±0 Blood transfusion（mean±SD /L） 0.07±0.27 0.06±0.21 Operation time (mean±SD /min) 208.6±82.5 236.2±79.4 Vascular invasion（n） Positive 18 10 Negative 55 45 Bile leakage（n） Positive 11 2 Negative 62 53 Postoperative hospital stay (mean±SD /day) 8.0±2.7 7.8±2.8 Cutting edge（n） Positive 1 0 Negative 72 55 Width of cutting edge(mean±SD/cm) 1.68±0.5 1.56±0.5 Additional nodules found during surgery（n） 0 6 Intraoperative cyst destruction（n） Positive 3 0 Negative 70 55 Child–Pugh class A（n） 73 55 Recurrence and metastasis within one year（n） 8 4 Pathological results（n） High 3 9 Middle 58 43 Low 12 3 According to the Barcelona staging criteria,all patients were in stage A.Preoperative liver function Child-Pugh classification was grade A.All patients underwent laparoscopic surgery. According to Table 1,there was no significant difference in age,gender,hepatitis B,cirrhosis,surgical method,operation time,postoperative hospital stay,incision margin width,vascular invasion and pathological results between the non-fluorescence group and the fluorescence group.In terms of surgical margin,the surgical margin of the fluorescence group was negative,and 1 case of surgical margin was positive in the non-fluorescence group(1/73).There was no capsule destruction in the fluorescence group,and there were 3 cases of capsule destruction in the non-fluorescence group(3/73).There were 6 cases of abnormal nodules found in the fluorescence group,which were not found in the preoperative imaging examination.The pathological diagnosis was positive in 3 cases. Compared with the non-fluorescence group,the intraoperative blood loss in the fluorescence group was significantly reduced(P<0.05),and the incidence of postoperative bile leakage was reduced(P<0.05).The above data were statistically significant. According to the recurrence and metastasis rate at 1 year after operation,the recurrence and metastasis rate of the fluorescence group was 7.27%,and the recurrence and metastasis rate of the non-fluorescence group was 10.96%.Compared with the two groups of data,the recurrence and metastasis rate of the fluorescence group had a decreasing trend.In the 1-year follow-up of 128 patients,one patient died of cerebral hemorrhage,but no tumor recurrence and metastasis was found,which did not affect the results of the study. The tumor fluorescence characteristics of 55 cases of laparoscopic liver tumor resection under ICG navigation are shown in Table 2. Table 2. Tumor fluorescence characteristics of 55 cases of laparoscopic liver tumor resection under ICG navigation n Complete staining 9 Partial staining 43 Ring staining 3 Combined with postoperative pathology,it was confirmed that under the near-infrared light camera,highly differentiated tumors showed complete fluorescence(figure1A),moderately differentiated tumors showed partial fluorescence(figure1B),and poorly differentiated tumors showed ring fluorescence(figure1C). DISCUSSION An appropriate width of the liver resection margin is crucial for the prognosis and survival of patients with liver cancer. [ 9 ] Therefore,surgeons are actively exploring the real-time visualization technology of intraoperative liver cancer,so as to achieve this goal.Conventional laparoscopic surgery can only rely on the surgeon's memory of preoperative imaging images and experience to determine the location and edge of the tumor.During the operation,it is easy to cause the resection plane to shift,resulting in insufficient resection margin or positive resection margin,and even intraoperative destruction of the tumor capsule,resulting in catastrophic consequences of iatrogenic tumor spread. The application of ICG in liver cancer resection brings more advantages for laparoscopic hepatectomy. [ 10 ][ 11 ][ 12 ] The intraoperative real-time visualization of ICG fluorescence as a roadmap in liver tumor resection helps surgeons to determine that the cutting line retains sufficient width to ensure a negative surgical margin. [ 13 ][ 14 ] Because the metabolic rate of ICG in liver cancer cells is lower than that in normal liver cells,liver cancer cells show obvious green fluorescence under near-infrared light camera.At the same time,the metabolic rate of ICG in normal liver cells around liver cancer cells is also lower than that in normal liver cells.Therefore,the boundary of ICG fluorescence is not equal to the boundary of liver tumor,and its width must be wider than the boundary of tumor.Therefore,under the technology of fluorescence imaging,it is more conducive to R0 resection of liver tumor.At the same time,due to the relationship between ICG fluorescence imaging and tumor differentiation,for MVI-positive patients,according to the preliminary judgment of tumor differentiation during surgery and the location of tumor thrombus,surgeons can determine whether to expand the resection range during surgery. [ 15 ][ 16 ] If necessary,it can be changed from non-anatomical resection to anatomical resection to avoid recurrence and metastasis of cancer due to residual cancer cells. ICG fluorescence real-time imaging is conducive to the discovery of small nodules that are difficult to be found in preoperative imaging examinations during surgery, [ 17 ] and small tumors with a diameter of less than 5mm or even less than 3mm can be found.In this study,6 of the 55 patients who underwent laparoscopic liver tumor resection under ICG navigation were found to have small nodules(10.9%)during the operation due to ICG fluorescence imaging,of which 3 cases(50%)were positive.Excision of these nodules at the same time is beneficial to reduce the recurrence rate of patients,reduce the possibility of metastasis,and prolong their survival. The perfusion of ICG to the liver is beneficial for surgeons to distinguish between liver parenchyma and blood vessels, [ 18 ] so as to better open the liver parenchyma between non-vascular areas,prevent intrahepatic vascular injury,and reduce intraoperative bleeding.At the same time,ICG navigation helps doctors display the location and boundary of the tumor in real time and three-dimensionally.The resection target is clear,which can achieve accurate resection,reduce unnecessary tissue damage,and reduce intraoperative bleeding.In this study,the intraoperative blood loss in the fluorescence group was 43.8% less than that in the non-fluorescence group.According to the literature,more than 50% of surgeons have experienced bile duct injury.The main cause of bile duct injury is intraoperative bile duct identification error.Therefore,intraoperative accurate identification of intrahepatic and extrahepatic bile ducts is the key means to avoid bile duct injury. [ 19 ] Traditional intraoperative cholangiography is less used in surgery due to long consumption time,large radiation,and inability to perform real-time cholangiography.Using the characteristic that ICG is excreted by the biliary system,peripheral intravenous injection of ICG or intraoperative injection of ICG in the biliary tract is simple and convenient, [ 20 ][ 21 ] which can reduce the difficulty of surgery and reduce the damage to the bile duct.Under the real-time imaging of ICG fluorescence,it is helpful for surgeons to identify the anatomical structure of intrahepatic and extrahepatic bile ducts, [ 22 ][ 23 ][ 24 ] detect the anatomical variation of bile ducts in time during operation,and reduce the damage to bile ducts.At the same time, it is helpful for surgeons to detect small bile leakage in time and repair it in time,so as to reduce the probability of postoperative bile leakage. [ 25 ] In addition,the application of ICG reduces the chance of postoperative residual non-functional liver infection and reduces bile leakage.In this study,there were 2 cases of bile leakage in the fluorescence group and 11 cases of bile leakage in the non-fluorescence group,with a decrease of 81.8%. The fluorescence display type of ICG has a certain correlation with the degree of differentiation of liver cancer. [ 26 ][ 27 ] In this study,most of the well-differentiated liver cancer showed complete fluorescence,the moderately differentiated liver cancer showed partial fluorescence,and the poorly differentiated liver cancer showed ring fluorescence.In addition to the differentiation of tumor tissue,this fluorescence display mode of liver cancer may also be related to the background of liver cancer, [ 28 ] which needs further grouping study.ICG also has the disadvantage of high false positive,which cannot be ignored.For patients with cirrhosis,due to the weakening of their liver tissue metabolic capacity,if there is no appropriate increase in the metabolic time after medication,there will be false positives,which seriously affects the surgeon 's intraoperative judgment.Due to the limitation of permeability,it can only show 5-10mm under the liver capsule,and cannot show deeper tumors,which also leads to a decrease in its sensitivity to deep tumors. CONCLUSIONS Under the real-time fluorescence navigation of ICG,the surgical margin can be better determined.The fluorescence type is related to the degree of tumor differentiation.Surgeons can judge the type of tumor during the operation and determine whether to expand the resection range to retain sufficient margin to prevent tumor capsule destruction.Resection of liver tumors can effectively reduce vascular injury and reduce intraoperative blood loss.It can find small nodules that are difficult to be found by preoperative imaging examination during operation,reduce the recurrence and metastasis of patients after operation,and is conducive to the prognosis and survival of patients.Under the guidance of ICG,it can also help to identify the bile duct during the operation,reduce the damage to the bile duct and reduce the incidence of bile leakage. [ 29 ][ 30 ] Abbreviations ICG Indocyanine Green MVI Microvascular Invasion Declarations Ethics approval and consent to participate This study was approved by the Human Research Ethics Committee of the Affiliated Hospital of Putian University (Approval No.:The Ethics Committee of Putian University Affiliated Hospital [202539]) and carried out in accordance with the Helsinki Declaration. All the participants were informed, and written informed consent was obtained. Consent for publication Not Applicable Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request Competing interests The authors declare no competing interests Funding Not Applicable. Authors’ contributions Xiao-jie Jiang (Co-First Author): Surgical implementation, formal analysis, and manuscript review. Ke-hao Huang(Co-First Author): Conceptualization, methodology, clinical data collection, and original draft preparation. Chang-xi Liao, Wei Lin, Jian-xin Yang, Han Shi(Co-Authors): Pathological evaluation, statistical analysis, and visualization. Qing-he Cai, Jian-feng Zhao(Corresponding Authors): Supervision,project administration, and final manuscript editing. Acknowledgements We appreciate all the authors who have made efforts in the entire program. 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02:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7033412/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7033412/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90472718,"identity":"40521115-10f0-4717-aa99-f6017c91b9ee","added_by":"auto","created_at":"2025-09-03 06:36:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1221060,"visible":true,"origin":"","legend":"\u003cp\u003ehighly differentiated tumors showed complete fluorescence(A),moderately differentiated tumors showed partial fluorescence(B),and poorly differentiated tumors showed ring fluorescence(C).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7033412/v1/56b2c05048f79e93e9ccbf12.png"},{"id":92246523,"identity":"d0bc74d4-c194-48eb-a043-8cf3cd65796d","added_by":"auto","created_at":"2025-09-26 09:47:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2397248,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7033412/v1/1ccc9dcf-ea4b-4580-8260-b9140c77ef2d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application Research of Indocyanine Green Fluorescence in Laparoscopic Hepatectomy for Liver Tumors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAt present,hepatocellular carcinoma is one of the most common malignant tumors,and surgical treatment is the most important treatment.\u003csup\u003e[1]\u003c/sup\u003eSince the first laparoscopic hepatectomy was carried out in 1992,the minimally invasive surgery of laparoscopic hepatectomy has been rapidly developed.\u003csup\u003e[2]\u003c/sup\u003eHowever,laparoscopic surgery has the disadvantage of being unable to palpate,and it is difficult to locate the specific location and boundary of the tumor during the operation,resulting in prolonged operation time,and may even lead to serious consequences such as yaw of the surgical path and entering the tumor.Therefore,hepatobiliary surgeons are constantly exploring how to improve the efficacy of minimally invasive surgery while pursuing minimally invasive surgery.\u003csup\u003e[3]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn 2009,Ishizawa et al.first applied ICG fluorescence imaging technology to liver resection surgery.\u003csup\u003e[4]\u003c/sup\u003e\u003csup\u003e[5]\u003c/sup\u003e\u003csup\u003e[6]\u003c/sup\u003eThe research and application of ICG fluorescence imaging technology in precise resection of liver tumors have been continuously improved.This study retrospectively analyzed the patients who underwent laparoscopic liver tumor resection using ICG navigation technology in our hospital,and explored the value of ICG navigation technology in laparoscopic liver tumor resection.\u003csup\u003e[7]\u003c/sup\u003e\u003csup\u003e[8]\u003c/sup\u003e\u003c/p\u003e"},{"header":"PATIENTS AND METHODS","content":"\u003cp\u003ePatients\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Review Committee of the Affiliated Hospital of Putian University.A total of 128 patients with hepatocellular carcinoma were enrolled in the Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Hospital of Putian University from July 2021 to July 2023.Among them,73 patients underwent conventional laparoscopic liver tumor resection(non-fluorescence group)and 55 patients underwent laparoscopic liver tumor resection under ICG navigation(fluorescence group).\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eFifty-five patients met the recommendation 3 in the consensus guidelines for the application of fluorescence imaging in hepatobiliary surgery.ICG 0.5mg/kg was injected intravenously 48-72 hours before operation.Informed consent of patients and their families was obtained before injection of ICG.The near-infrared light camera was used to detect the fluorescence intensity of ICG during the operation.Under the fluorescence imaging of ICG,the edge of the liver tumor was marked with an electric knife,and tiny nodules that were difficult to be found by preoperative imaging examination could also be observed.After liver tumor resection,the ICG fluorescence effect was used to check the surgical margin plane of the liver to check whether the resection was clean.\u003c/p\u003e\n\u003cp\u003eSpecimen pathological examination\u003c/p\u003e\n\u003cp\u003eAll specimens were diagnosed by two experienced pathologists.The degree of tumor differentiation,the nature of the cutting edge,the width of the cutting edge,and the vascular tumor thrombus were analyzed.\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u003c/p\u003e\n\u003cp\u003eQuantitative data were expressed as mean\u0026plusmn;standard deviation.Chi-square test and t test were used for qualitative data and quantitative data respectively.If P\u0026lt;0.05,it was considered statistically significant.SPSS 29.0 software was used for statistical analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe clinical characteristics of 73 patients undergoing conventional laparoscopic liver tumor resection(non-fluorescence group)and 55 patients undergoing laparoscopic liver tumor resection under ICG navigation(fluorescence group)are shown in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. \u0026nbsp;clinical characteristics of 73 patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNot-using ICG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eUsing ICG\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eGender(n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAge(mean\u0026plusmn;SD/year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e60.0\u0026plusmn;12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e64.2\u0026plusmn;13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHBsAg(n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eLive cirrhosis(n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSurgical procedure (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAnatomical resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNonanatomical resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBlood loss (mean\u0026plusmn;SD/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0.32\u0026plusmn;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0.18\u0026plusmn;0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBlood replacement (mean\u0026plusmn;SD/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0\u0026plusmn;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0\u0026plusmn;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBlood transfusion（mean\u0026plusmn;SD /L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0.07\u0026plusmn;0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0.06\u0026plusmn;0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOperation time (mean\u0026plusmn;SD /min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e208.6\u0026plusmn;82.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e236.2\u0026plusmn;79.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eVascular invasion（n）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBile leakage（n）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePostoperative hospital stay (mean\u0026plusmn;SD /day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e8.0\u0026plusmn;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e7.8\u0026plusmn;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCutting edge（n）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWidth of cutting edge(mean\u0026plusmn;SD/cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1.68\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1.56\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAdditional nodules found during surgery（n）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eIntraoperative cyst destruction（n）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eChild\u0026ndash;Pugh class A（n）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRecurrence and metastasis within one year（n）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePathological results（n）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAccording to the Barcelona staging criteria,all patients were in stage A.Preoperative liver function Child-Pugh classification was grade A.All patients underwent laparoscopic surgery.\u003c/p\u003e\n\u003cp\u003eAccording to Table 1,there was no significant difference in age,gender,hepatitis B,cirrhosis,surgical method,operation time,postoperative hospital stay,incision margin width,vascular invasion and pathological results between the non-fluorescence group and the fluorescence group.In terms of surgical margin,the surgical margin of the fluorescence group was negative,and 1 case of surgical margin was positive in the non-fluorescence group(1/73).There was no capsule destruction in the fluorescence group,and there were 3 cases of capsule destruction in the non-fluorescence group(3/73).There were 6 cases of abnormal nodules found in the fluorescence group,which were not found in the preoperative imaging examination.The pathological diagnosis was positive in 3 cases.\u003c/p\u003e\n\u003cp\u003eCompared with the non-fluorescence group,the intraoperative blood loss in the fluorescence group was significantly reduced(P\u0026lt;0.05),and the incidence of postoperative bile leakage was reduced(P\u0026lt;0.05).The above data were statistically significant.\u003c/p\u003e\n\u003cp\u003eAccording to the recurrence and metastasis rate at 1 year after operation,the recurrence and metastasis rate of the fluorescence group was 7.27%,and the recurrence and metastasis rate of the non-fluorescence group was 10.96%.Compared with the two groups of data,the recurrence and metastasis rate of the fluorescence group had a decreasing trend.In the 1-year follow-up of 128 patients,one patient died of cerebral hemorrhage,but no tumor recurrence and metastasis was found,which did not affect the results of the study.\u003c/p\u003e\n\u003cp\u003eThe tumor fluorescence characteristics of 55 cases of laparoscopic liver tumor resection under ICG navigation are shown in Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2. Tumor fluorescence characteristics of 55 cases of laparoscopic liver tumor resection under ICG navigation\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eComplete staining\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003ePartial staining\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eRing staining\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCombined with postoperative pathology,it was confirmed that under the near-infrared light camera,highly differentiated tumors showed complete fluorescence(figure1A),moderately differentiated tumors showed partial fluorescence(figure1B),and poorly differentiated tumors showed ring fluorescence(figure1C).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAn appropriate width of the liver resection margin is crucial for the prognosis and survival of patients with liver cancer.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003eTherefore,surgeons are actively exploring the real-time visualization technology of intraoperative liver cancer,so as to achieve this goal.Conventional laparoscopic surgery can only rely on the surgeon's memory of preoperative imaging images and experience to determine the location and edge of the tumor.During the operation,it is easy to cause the resection plane to shift,resulting in insufficient resection margin or positive resection margin,and even intraoperative destruction of the tumor capsule,resulting in catastrophic consequences of iatrogenic tumor spread.\u003c/p\u003e\u003cp\u003eThe application of ICG in liver cancer resection brings more advantages for laparoscopic hepatectomy.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e][\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e][\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003eThe intraoperative real-time visualization of ICG fluorescence as a roadmap in liver tumor resection helps surgeons to determine that the cutting line retains sufficient width to ensure a negative surgical margin.\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e][\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003eBecause the metabolic rate of ICG in liver cancer cells is lower than that in normal liver cells,liver cancer cells show obvious green fluorescence under near-infrared light camera.At the same time,the metabolic rate of ICG in normal liver cells around liver cancer cells is also lower than that in normal liver cells.Therefore,the boundary of ICG fluorescence is not equal to the boundary of liver tumor,and its width must be wider than the boundary of tumor.Therefore,under the technology of fluorescence imaging,it is more conducive to R0 resection of liver tumor.At the same time,due to the relationship between ICG fluorescence imaging and tumor differentiation,for MVI-positive patients,according to the preliminary judgment of tumor differentiation during surgery and the location of tumor thrombus,surgeons can determine whether to expand the resection range during surgery.\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e][\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003eIf necessary,it can be changed from non-anatomical resection to anatomical resection to avoid recurrence and metastasis of cancer due to residual cancer cells.\u003c/p\u003e\u003cp\u003eICG fluorescence real-time imaging is conducive to the discovery of small nodules that are difficult to be found in preoperative imaging examinations during surgery,\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003eand small tumors with a diameter of less than 5mm or even less than 3mm can be found.In this study,6 of the 55 patients who underwent laparoscopic liver tumor resection under ICG navigation were found to have small nodules(10.9%)during the operation due to ICG fluorescence imaging,of which 3 cases(50%)were positive.Excision of these nodules at the same time is beneficial to reduce the recurrence rate of patients,reduce the possibility of metastasis,and prolong their survival.\u003c/p\u003e\u003cp\u003eThe perfusion of ICG to the liver is beneficial for surgeons to distinguish between liver parenchyma and blood vessels,\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003eso as to better open the liver parenchyma between non-vascular areas,prevent intrahepatic vascular injury,and reduce intraoperative bleeding.At the same time,ICG navigation helps doctors display the location and boundary of the tumor in real time and three-dimensionally.The resection target is clear,which can achieve accurate resection,reduce unnecessary tissue damage,and reduce intraoperative bleeding.In this study,the intraoperative blood loss in the fluorescence group was 43.8% less than that in the non-fluorescence group.According to the literature,more than 50% of surgeons have experienced bile duct injury.The main cause of bile duct injury is intraoperative bile duct identification error.Therefore,intraoperative accurate identification of intrahepatic and extrahepatic bile ducts is the key means to avoid bile duct injury.\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003eTraditional intraoperative cholangiography is less used in surgery due to long consumption time,large radiation,and inability to perform real-time cholangiography.Using the characteristic that ICG is excreted by the biliary system,peripheral intravenous injection of ICG or intraoperative injection of ICG in the biliary tract is simple and convenient,\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e][\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003ewhich can reduce the difficulty of surgery and reduce the damage to the bile duct.Under the real-time imaging of ICG fluorescence,it is helpful for surgeons to identify the anatomical structure of intrahepatic and extrahepatic bile ducts,\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e][\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e][\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003edetect the anatomical variation of bile ducts in time during operation,and reduce the damage to bile ducts.At the same time, it is helpful for surgeons to detect small bile leakage in time and repair it in time,so as to reduce the probability of postoperative bile leakage.\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003eIn addition,the application of ICG reduces the chance of postoperative residual non-functional liver infection and reduces bile leakage.In this study,there were 2 cases of bile leakage in the fluorescence group and 11 cases of bile leakage in the non-fluorescence group,with a decrease of 81.8%.\u003c/p\u003e\u003cp\u003eThe fluorescence display type of ICG has a certain correlation with the degree of differentiation of liver cancer.\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e][\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003eIn this study,most of the well-differentiated liver cancer showed complete fluorescence,the moderately differentiated liver cancer showed partial fluorescence,and the poorly differentiated liver cancer showed ring fluorescence.In addition to the differentiation of tumor tissue,this fluorescence display mode of liver cancer may also be related to the background of liver cancer,\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003ewhich needs further grouping study.ICG also has the disadvantage of high false positive,which cannot be ignored.For patients with cirrhosis,due to the weakening of their liver tissue metabolic capacity,if there is no appropriate increase in the metabolic time after medication,there will be false positives,which seriously affects the surgeon 's intraoperative judgment.Due to the limitation of permeability,it can only show 5-10mm under the liver capsule,and cannot show deeper tumors,which also leads to a decrease in its sensitivity to deep tumors.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eUnder the real-time fluorescence navigation of ICG,the surgical margin can be better determined.The fluorescence type is related to the degree of tumor differentiation.Surgeons can judge the type of tumor during the operation and determine whether to expand the resection range to retain sufficient margin to prevent tumor capsule destruction.Resection of liver tumors can effectively reduce vascular injury and reduce intraoperative blood loss.It can find small nodules that are difficult to be found by preoperative imaging examination during operation,reduce the recurrence and metastasis of patients after operation,and is conducive to the prognosis and survival of patients.Under the guidance of ICG,it can also help to identify the bile duct during the operation,reduce the damage to the bile duct and reduce the incidence of bile leakage.\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e][\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eICG \u0026nbsp;Indocyanine Green\u003c/p\u003e\n\u003cp\u003eMVI \u0026nbsp;Microvascular Invasion\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Human Research Ethics Committee of the Affiliated Hospital of Putian University (Approval No.:The Ethics Committee of Putian University Affiliated Hospital [202539]) and carried out in accordance with the Helsinki Declaration. All the participants were informed, and written informed consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiao-jie Jiang (Co-First Author): Surgical implementation, formal analysis, and manuscript review.\u003c/p\u003e\n\u003cp\u003eKe-hao Huang(Co-First Author): Conceptualization, methodology, clinical data collection, and original draft preparation.\u003c/p\u003e\n\u003cp\u003eChang-xi Liao, Wei Lin, Jian-xin Yang, Han Shi(Co-Authors): Pathological evaluation, statistical analysis, and visualization.\u003c/p\u003e\n\u003cp\u003eQing-he Cai, Jian-feng Zhao(Corresponding Authors): Supervision,project administration, and final manuscript editing.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciate all the authors who have made efforts in the entire program.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEuropean Association For The Study Of The Liver. and European Organisation For Research And Treatment Of Cancer. \u0026ldquo;EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma.\u0026rdquo; \u003cem\u003eJournal of hepatology\u003c/em\u003e vol. 56,4 (2012): 908-43. doi:10.1016/j.jhep.2011.12.001\u003c/li\u003e\n\u003cli\u003eCheung, Tan To et al. \u0026ldquo;The Asia Pacific Consensus Statement on Laparoscopic Liver Resection for Hepatocellular Carcinoma: A Report from the 7th Asia-Pacific Primary Liver Cancer Expert Meeting Held in Hong Kong.\u0026rdquo; \u003cem\u003eLiver cancer\u003c/em\u003e vol. 7,1 (2018): 28-39. doi:10.1159/000481834\u003c/li\u003e\n\u003cli\u003eLai, E C et al. \u0026ldquo;Hepatectomy for large hepatocellular carcinoma: the optimal resection margin.\u0026rdquo; \u003cem\u003eWorld journal of surgery\u003c/em\u003e vol. 15,1 (1991): 141-5. doi:10.1007/BF01658988\u003c/li\u003e\n\u003cli\u003eMorise, Zenichi et al. \u0026ldquo;Recent advances in liver resection for hepatocellular carcinoma.\u0026rdquo; \u003cem\u003eFrontiers in surgery\u003c/em\u003e vol. 1 21. 16 Jun. 2014, doi:10.3389/fsurg.2014.00021\u003c/li\u003e\n\u003cli\u003eIshizawa, Takeaki et al. \u0026ldquo;Real-time identification of liver cancers by using indocyanine green fluorescent imaging.\u0026rdquo; 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0.05),and the incidence of bile leakage was reduced(P \u0026lt; 0.05).The above data were statistically significant.Under the near-infrared light camera,the highly differentiated tumors showed complete fluorescence,the moderately differentiated tumors showed partial fluorescence,and the poorly differentiated tumors showed ring fluorescence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e:The surgical margin can be better determined under the real-time fluorescence navigation of ICG,and the fluorescence type is related to the degree of tumor differentiation.It can effectively reduce the amount of bleeding during operation.Micronodules that are difficult to find by preoperative imaging examination can be found during the operation.It can also facilitate the identification of bile ducts during surgery and reduce the incidence of bile leakage.\u003c/p\u003e","manuscriptTitle":"Application Research of Indocyanine Green Fluorescence in Laparoscopic Hepatectomy for Liver Tumors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 06:36:17","doi":"10.21203/rs.3.rs-7033412/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5b52891-4da2-4c1c-bd02-4a988f56092d","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-26T09:39:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-03 06:36:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7033412","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7033412","identity":"rs-7033412","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}