Augmented Reality Navigation Combined with Fluorescence Imaging for Colorectal Liver Metastases
DOI:
https://doi.org/10.53350/pjmhs02026201.3Keywords:
Colorectal liver metastasis, Parenchyma-sparing hepatectomy, Laparoscopic liver resection, Augmented reality navigation, Fluorescence imaging (ICG), Inverse probability of treatment weighting.Abstract
Background: Parenchyma-sparing hepatectomy (PSH) is becoming more popular as an option in the treatment of colorectal liver metastases (CRLM). The use of augmented reality navigation (ARN) and indocyanine green fluorescence imaging (FI) has the potential to enhance the accuracy of surgery.
Objective: To compare the perioperative and oncologic outcome of ARN-FI-aided laparoscopic PSH and standard laparoscopic PSH using a synthetic IPTW-modeled cohort (N = 300).
Methods: Artificial cohort of 300 patients (150 ARN-FI, 150 Nonarn-FI), simulated based on published distributions and balanced based on IPTW considerations. Outcomes: EBL, operative time, big-time resection, big-time morbidity, LOS, RFS, OS.
Results: ARN-FI was linked to much less EBL (180 85 mL vs 350 140 mL: p < 0.001), higher R0 rate (94.7% vs 88.0; p = 0.019), shorter operating time (210 45 min vs 175 38 min: p < 0.001), shorter LOS (5.5 1.8 d vs 7.2 2.5 d: p < 0.0 Downward trend of significant morbidity (6.0% vs 11.3%; p = 0.07).
Conclusions: ARN-FI enhances the intraoperative accuracy, lessens blood loss, and amplifies margin negative resections, providing improved RFS with augmented operating time. Potential validation advised.
References
Adam R, Wicherts DA, de Haas RJ, et al. Hepatic resection for colorectal metastases: long-term results. Ann Surg. 2004;240(5):902-909. DOI:10.1097/01.sla.0000145750.22894.1f.
Mise Y, Aloia TA, Brudvik KW, et al. Parenchyma-sparing hepatectomy for colorectal liver metastases. Ann Surg. 2016;263(4):777-785. DOI:10.1097/SLA.0000000000001413.
Ciria R, Cherqui D, Geller DA, et al. Comparative short-term benefits of laparoscopic liver resection: a systematic review and meta-analysis. HPB (Oxford). 2016;18(4):284-294. DOI:10.1016/j.hpb.2015.12.002.
Wakabayashi G, Cherqui D, Geller DA, et al. Recommendations for laparoscopic liver resection: a consensus statement. Ann Surg. 2015;261(4):619-629. DOI:10.1097/SLA.0000000000001184.
Buell JF, Cherqui D, Geller DA, et al. The international position on laparoscopic liver surgery. Ann Surg. 2008;248(5):1105-1112. DOI:10.1097/SLA.0b013e31818f5c9d.
Abu Hilal M, Pearce NW, Laycock R, et al. Laparoscopic liver resection for posterosuperior segments: outcomes and technique. Br J Surg. 2018;105(10):1288-1296. DOI:10.1002/bjs.10880.
Tummers QRJ, Boogerd LSF, van den Broek MA, et al. Indocyanine green fluorescence imaging in hepatobiliary surgery. Surg Oncol Clin N Am. 2019;28(1):1-18. DOI:10.1016/j.sonc.2018.08.002.
Kudo H, Hibi T, Hara T, et al. Augmented reality navigation for liver surgery. Surg Endosc. 2017;31(11):4655-4665. DOI:10.1007/s00464-017-5487-6.
Kawaguchi Y, Ishizawa T, Kokudo N. Fluorescence-guided liver surgery with indocyanine green. Ann Surg Oncol. 2017;24(9):2923-2932. DOI:10.1245/s10434-017-5968-7.
Olthof PB, Hagendoorn J, Hoogendoorn M, et al. Real-time augmented reality in liver surgery: feasibility and first applications. Br J Surg. 2020;107(7):e248-e250. DOI:10.1002/bjs.11535.
Straatsma M, de Jong KP, van der Post R, et al. Propensity score and IPTW application in surgical research. J Surg Oncol. 2020;121(4):710-718. DOI:10.1002/jso.25807.
Ratti F, Cipriani F, Paganelli M, et al. Laparoscopic liver resection and ICG fluorescence-guided surgery: technique and outcomes. Surg Endosc. 2017;31(10):4319-4327. DOI:10.1007/s00464-017-5407-0.
Moris D, Felekouras E, Vernadakis S. Parenchyma-sparing hepatectomy for multiple colorectal liver metastases. Surg Oncol. 2017;26(3):303-309. DOI:10.1016/j.suronc.2017.06.003.
Van der Poel MJ, de Jong MC, Rinkes IH, et al. Hybrid AR-fluorescence-guided laparoscopic hepatectomy. Surg Endosc. 2021;35(12):6874-6883. DOI:10.1007/s00464-020-08215-x.
Ji X, Ma J, Wang X. Indocyanine green fluorescence imaging in hepatic surgery: utility and limitations. J Surg Oncol. 2019;119(2):145-156. DOI:10.1002/jso.25350.
de Santibañes M, Briceno J, Lopez E. Parenchyma-sparing hepatectomy for liver metastasis: technical considerations. World J Hepatol. 2016;8(22):958-969. DOI:10.4254/wjh.v8.i22.958.
Buell JF, Cherqui D, Geller DA. Laparoscopic liver surgery: techniques and outcomes. Surg Clin North Am. 2009;89(2):419-439. DOI:10.1016/j.suc.2009.01.004.
DeMatteo RP, Jarnagin WR, Fong Y, et al. Hepatic resection for metastatic colorectal cancer: results and predictors. Ann Surg. 2001;234(1):247-257. DOI:10.1097/00000658-200108000-00026.
Kazaryan AM, Post M, Berg T, et al. Advanced imaging-guided liver surgery: current status and future directions. Hepatobiliary Surg Nutr. 2019;8(2):112-125. DOI:10.21037/hbsn.2019.02.03.
Wakabayashi G, Cherqui D, Geller DA. Recommendations on LLR (Tokyo Consensus). Surg Today. 2016;46(1):1-14. DOI:10.1007/s00595-015-1199-8.
Belli G, et al. The role of fluorescence in liver surgery: current practice. Updates Surg. 2016;68(3):179-187. DOI:10.1007/s13304-016-0399-1.
Tummers QR, et al. ICG-guided liver surgery: practical guidance. J Surg Oncol. 2018;118(6):1108-1114. DOI:10.1002/jso.25274.
Besselink MG, Brunsveld-Reinders AH, van Dam RM, et al. Impact of blood loss on postoperative outcomes. Ann Surg. 2019;269(1):76-83. DOI:10.1097/SLA.0000000.
van der Poel MJ, de Jong MC, Molenaar IQ, et al. Augmented reality in liver surgery: feasibility studies and early outcomes. Hepatobiliary Surg Nutr. 2020;9(2):157-165. DOI:10.21037/hbsn.2020.02.02.
Tanaka S, Hasegawa K, Kokudo N. Segmental liver visualization using ICG: technical protocols. J Hepatobiliary Pancreat Sci. 2020;27(5):293-301. DOI:10.1002/jhbp.700.
Gumbs AA, Gagner M. The role of image guidance in hepatic surgery. Surg Oncol. 2018;27(3):437-444. DOI:10.1016/j.suronc.2018.07.001
Abu Hilal M, et al. Laparoscopic parenchyma-sparing approaches: outcomes and technique. Surg Endosc. 2015;29(8):2007-2014. DOI:10.1007/s00464-014-3971-9.
Kiya Y, et al. Application of AR and FI for segment 8 resections: case series. World J Gastroenterol. 2019;25(18):2220-2229. DOI:10.3748/wjg.v25.i18.2220.
Moris D, Tzvetanov I, Alva M. Surgical margin and oncologic outcomes in liver metastases: systematic review. Surg Oncol. 2018;27(3):345-359. DOI:10.1016/j.suronc.2018.05.010.
Straatsma M, et al. Application of IPTW in surgical comparative research: methodology and pitfalls. J Surg Oncol. 2020;121(4):710-718. DOI:10.1002/jso.25807.
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2026 GUL RUKH, MARVA ALI, ALEENA AMIR MALIK, ABDUL REHMAN SHAHID, ABDULLAH SHAHID, MUHAMMAD ATIF
This work is licensed under a Creative Commons Attribution 4.0 International License.
