Combined intraoperative use of contrast-enhanced ultrasonography imaging using a sonazoid and fluorescence navigation system with indocyanine green during anatomical hepatectomy.

Purpose: The clear demarcation line is ideal for real-time surgical navigation imaging during hepatectomy.

Methods: The study population was comprised of 22 patients with moderate liver cirrhosis scheduled to undergo an anatomical liver resection for the treatment of hepatocellular carcinoma. This study set out to assess the clinical value of the concomitant intra-operative use of contrast-enhanced intra-operative ultrasound using Sonazoid™, and a fluorescence navigation system (PDE) with ICG, as a novel tool for patients undergoing an anatomical liver resection.

Results: Following portal pedicle ligation for anatomical resection, 2 min after injection of ICG, the segments to be resected were detected as a negative-brightness area using PDE fluorescence. Sonazoid™ administration provides a parenchymal transectional line, as the margin of a loss of blood flow shows a hypo-enhanced image, and the resectional line of the parenchyma can be confirmed by CE-IOUS. Although the demarcation line of the liver surface after the portal pedicle ligation was apparent in 17 patients, the resection line using PDE was clearly detected in all 22 patients (p < 0.018).

Conclusions: The combined use of these methods is therefore considered to be useful and safe for surgeons, as an additional tool for performing a liver resection.