ArticleSurgical endoscopy2026
Clinical impact of indocyanine green fluorescence imaging on perioperative outcomes in laparoscopic anatomical liver segmentectomy.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLaparoscopic anatomical segmentectomy is technically demanding due to the lack of visible surface landmarks identifying segmental borders. While indocyanine green (ICG) fluorescence imaging offers real-time navigation, its specific impact on anatomical orientation remains understudied. We evaluated the clinical impact of ICG fluorescence guidance on perioperative efficiency and outcomes in laparoscopic anatomical segmentectomy.
methodsWe analyzed 78 consecutive patients (2017-2025) undergoing laparoscopic anatomical segmentectomy, stratified into ICG-guided (n = 51, negative staining) and conventional (n = 27) groups. Endpoints included perioperative outcomes (operative time, complications, and hospital stay), anatomical precision (RMSE between simulated volume and specimen weight), and long-term prognosis (RFS/OS) in a hepatocellular carcinoma (HCC) subgroup operated before 2023.
resultsWhile the non-ICG group included a higher proportion of high-difficulty cases according to the IWATE criteria (85.2 vs. 58.8%; p = 0.022), the ICG group demonstrated a substantially shorter median operative time (369 vs. 478 min; p < 0.001). Notably, the ICG group achieved zero major morbidity (Clavien-Dindo ≥ IIIa), whereas the conventional group had a rate of 22.2% (p < 0.001). The ICG group also showed superior anatomical precision with a lower RMSE (46.97 vs. 59.36). Intraoperative blood loss and R0 resection rates were comparable. Subgroup analysis confirmed that the ICG group maintained superior efficiency even in the later study period. In the HCC subset, RFS and OS were comparable between the groups (p = 0.352 and p = 0.080, respectively), indicating the oncological safety of the ICG-guided approach.
conclusionsICG fluorescence guidance with negative staining improves operative efficiency and safety in laparoscopic anatomical segmentectomy. By visualizing the otherwise invisible demarcation, this technique streamlines parenchymal transection and is associated with reduced major morbidity. While the baseline difficulty imbalance warrants cautious interpretation, our findings suggest that ICG navigation provides a feasible and promising approach for improving surgical precision and outcomes.
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