Laparoscopic hepatectomy and near-infrared fluorescence based on the concept of "biliary territory" in the treatment of hepatolithiasis: a propensity score-matched study with videos.

Background: Hepatolithiasis, a common condition in East Asia, often requires surgical treatment. The aim of this study was to evaluate the safety and efficacy of near-infrared fluorescence (NIF)-guided laparoscopic hepatectomy (LH) using the 'biliary territory' concept for hepatolithiasis. Methods: This retrospective study included 97 patients who had undergone LH for hepatolithiasis between June 2018 and November 2022. The patients were divided into two groups based on whether intraoperative NIF-guided (n=31) or traditional white light (WL) laparoscopy (n=66) had been performed. Propensity score matching (PSM) was used to create 27 pairs for comparison. Perioperative outcomes, stone recurrence, and recurrence-free survival (RFS) were assessed. Results: Prior to PSM, NIF guidance was associated with reduced bleeding (P=0.01) and a lower conversion rate (P=0.001). After PSM, only the postoperative albumin concentration differed significantly between the two groups (P=0.003). The median duration of follow-up was 36 months. Before PSM, RFS differed significantly between the groups (P=0.009), whereas in the matched cohort, the stone recurrence rate was 33.3% in the WL group and 7.4% in the NIF group; however, the RFS did not differ significantly between these groups (P=0.09). Postoperative complications were identified by Cox regression analysis as an independent risk factor for recurrence (95% CI: 1.02-15.21, P=0.047). Conclusions: NIF-guided LH is a safe and effective approach to the treatment of hepatolithiasis, long-term outcomes being comparable to those of traditional techniques. Future studies should be larger and have longer follow-up.