Efficacy of Augmented Reality Combined with Indocyanine Green Fluorescence Imaging Guided Laparoscopic Segmentectomy for Hepatocellular Carcinoma

Abstract

Background: The internal anatomy of the liver is extremely complex. Laparoscopic anatomical segmentectomy requires reference to the position and alignment of intrahepatic vascular. However, the surface of the liver lacks anatomical landmarks and the liver segment boundaries cannot be identified with the naked eye. Augmented reality navigation and indocyanine green fluorescence imaging are emerging navigation tools in liver resection. This study aims to explore the efficacy and application value of laparoscopic anatomical segmentectomy guided by augmented reality navigation combined with indocyanine green fluorescence imaging. Study Design: Nighty-eight patients who were diagnosed with hepatocellular carcinoma and underwent laparoscopic anatomical segmentectomy from January 2018 to January 2022 were retrospectively analyzed. They were divided into the ARN-FI group (45 patients) and the Non-ARN-FI group (53 patients) based on whether augmented reality navigation (ARN) combined with fluorescence imaging (FI) was applied during the operation. The differences in intraoperative and postoperative outcomes were compared. Results: There was no significant difference in preoperative baseline data and postoperative complication rates between the two groups. Compared with the Non-ARN-FI group, the ARN-FI group had much lower intraoperative blood loss (100ml vs. 200ml, P=0.005) and a lower incidence of remnant liver ischemia (13.3% vs. 30.2%, P=0.046). The 1-year and 3-year disease-free survival (DFS) rates in the ARN-FI and Non-ARN-FI groups were 91.01% versus 71.15%, and 70.01% versus 52.46%, respectively; the differences between the two groups were statistically significant (P=0.047). Conclusions: The ARN-FI technology provides a more standardized approach for liver parenchyma section during laparoscopic liver resection, effectively minimizing intraoperative blood loss, reducing postoperative remnant liver ischemia, as well as improving oncological prognosis. This method is safe and feasible, and has good clinical application prospects.