Arterial Base Fluorescence Segmental Positive Staining
Primary Purpose
Hepatic Carcinoma
Status
Completed
Phase
Not Applicable
Locations
Taiwan
Study Type
Interventional
Intervention
Superselective Intra-arterial Hepatic Injection of Indocyanine Green (ICG) for Fluorescence Image-guided Segmental Positive Staining
Sponsored by

About this trial
This is an interventional treatment trial for Hepatic Carcinoma focused on measuring indocynide green, Image guide surgery, near infra-red laparoscopy, laparoscopic hepatectomy
Eligibility Criteria
Inclusion Criteria:
- Single Hepatocellular carcinoma.
- plan of Laparoscopic hepatectomy.
- Age between 20 to 85 y/o.
Exclusion Criteria:
- allergies to iodine or ICG
- Liver cirrhosis
- coagulopathy
- chronic kidney disease
- pregnancy
Sites / Locations
- Chang Gung Memorial Hospital
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
super-selective hepatic artery ICG injection group
Arm Description
single arm for feasibility study of intra-hepatic artery base fluorescent segmental demarcation
Outcomes
Primary Outcome Measures
Fluorescent hepatic segment demarcation area
The surface size of fluorescent enhanced hepatic segment were measured as cm x cm .
the rate of fluorescent demarcation corresponding to US guide resection area
The evaluation of the fluorescent hepatic surface which is included in the resected area or not
The minimal distance between tumor and fluorescent margin
The distance between tumor edge and fluorescent parenchyma edge was measured as cm. This purpose was to evaluation the oncologic safety if the resection line is following the fluorescent margin
The minimal surgical margin
The distance between tumor edge and resected parenchyma edge was measured as cm.
surgical benefit rate of fluorescent image
If the fluorescent enhanced area is similar to resected parenchyma or the information of fluorescent image change the primary surgical plan, it was indicated benefit for surgery.
Secondary Outcome Measures
Post operative complication
any complication related to surgery
Post operative angiography procedure complication
any complication related to angiography procedure
Post operative hospital stay
The day in hospital after operation
Post operative Mortality
any mortality related to surgery
Full Information
NCT ID
NCT04266548
First Posted
February 6, 2020
Last Updated
February 10, 2020
Sponsor
Chang Gung Memorial Hospital
1. Study Identification
Unique Protocol Identification Number
NCT04266548
Brief Title
Arterial Base Fluorescence Segmental Positive Staining
Official Title
Superselective Intra-arterial Hepatic Injection of Indocyanine Green (ICG) for Fluorescence Image-guided Segmental Positive Staining
Study Type
Interventional
2. Study Status
Record Verification Date
February 2020
Overall Recruitment Status
Completed
Study Start Date
July 9, 2018 (Actual)
Primary Completion Date
December 6, 2019 (Actual)
Study Completion Date
January 6, 2020 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Chang Gung Memorial Hospital
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
More and more laparoscopic hepatectomy were performed due to increasing experience, well designed instruments and energy device. But the localization of tumor and resection line design are still relative difficult comparing open approach due to limit space. Intraoperative liver segmentation can be obtained by ultrasound-guide intraportal injection of a fluorophore and illuminating with a Near-Infrared light source for positive staining and by intravenous injection after ligation of segmental vessels for negative staining .The ultrasound guide intraportal injection approach is challenging in the minimally-invasive setting. However hepatocelluar carcinoma(HCC) was supplied by hepatic artery mainly. The investigators aimed to evaluate the feasibility of arterial base positive staining for fluorescence liver segmentation in human by superselective intra-hepatic artery injection of Indocyanine Green (ICG) .
Detailed Description
Materials and Methods
Participants The present prospective, single-center, feasibility study of fluorescence demarcation of hepatic segment including HCC by means of direct super-selective intrahepatic artery ICG injection. Patients were enrolled according to the following criteria: single HCC, scheduled for laparoscopic hepatectomy for curative resection, age ranging from 20 to 85 years old, absence of proven or suspected allergies to iodine or ICG, absence of coagulopathy, absence of diseases contraindicating general anesthesia, and absence of pregnancy.
All the bio-chemical test, cardiac echo , cardiac thalium test, ICG clearance test, Liver CT or MRI were obtained before operation
Equipment Endovascular procedure was performed in the conventional angiography room and laparoscopic hepatecotmy was done in operating room at the Kaohsiung Chang Gung memorial hospital. Near infra-red fluorescence laparoscopy was used to acquire the fluorescence signal arising from the liver parenchyma after Indocyanine Green (ICG) injection.
Procedures
Celiac trunk angiography and super-selective hepatic angiography:
A 4 Fr angiography sheath (Terumo Europe NV, Belgium) was placed under aseptic conditions in the right femoral artery, using the Seldinger technique. A 4 Fr Cobra-2 catheter (Terumo Europe NV, Belgium) was positioned at the origin of the celiac trunk. A selective celiac trunk digital subtraction angiographic (DSA) run was performed, after injection of a contrast medium (Visipaque 270, GE Healthcare; Buckinghamshire, United Kingdom), 28mL at a rate of 4mL/sec. A 2.7 French micro-catheter (Progreat™, Terumo Europe NV; Belgium) was used to super-selectively catheterize different hepatic segmental arteries supplying the target hepatic segment including HCC. In all cases, the position was controlled by performing DSA and angio computer tomography runs with selective micro-catheter injections. The micro-catheter was then perfused with saline and left in place until surgery. Then the patients were transferred to operative room while operative room available.
Evaluation of hepatic segmental demarcation using NIR real-time imaging during laparoscopic hepatectomy:
The patients underwent a standard 5-port laparoscopic hepatectomy, which was performed by 2 experienced laparoscopic surgeons .
Stage I : the liver mobilization was performed for preparing the hepatectomy. The intraoperative ultrasound was used for localization of HCC. The resection line was defined as principle of laparoscopic hepatectomy such as surgical margin, surgical volume and etc. The pringle control device was prepared.
Stage II : Rea-time enhanced visualization of the hepatic segment which were supplied feeding artery was achieved by means of fluorescence imaging using a direct selective intrahepatic artery injection of a 5 mL bolus of ICG (DiagnoGreen®, Taiwan, ROC) at a concentration of 0.125mg/mL. The demarcation of enhanced hepatic segment were defined. The correspondence between the fluorescence margin and ultrasound(US) guide resection line were analized.
Stage III: The surgical resection line was chose by real time clinical judgement including analysis of information of US, artery-base CT, fluorescence image, liver anatomy and patient condition. The laparoscopic hepatectomy was performed with pringle vascular control.
Stage IV: the specimen information including tumor size and margin in vitro was recoded. The distance between surgical margin and enhanced liver were measured.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatic Carcinoma
Keywords
indocynide green, Image guide surgery, near infra-red laparoscopy, laparoscopic hepatectomy
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
The study was the clinical feasibility study. Only selected single HCC patients was enrolled to study the feasibility of image guide surgery for laparoscopic hepatectomy
Masking
None (Open Label)
Allocation
N/A
Enrollment
8 (Actual)
8. Arms, Groups, and Interventions
Arm Title
super-selective hepatic artery ICG injection group
Arm Type
Experimental
Arm Description
single arm for feasibility study of intra-hepatic artery base fluorescent segmental demarcation
Intervention Type
Procedure
Intervention Name(s)
Superselective Intra-arterial Hepatic Injection of Indocyanine Green (ICG) for Fluorescence Image-guided Segmental Positive Staining
Intervention Description
The patients with single HCC which is planned to received laparoscopic hepatectomy were involved. Procedures were performed in conventional angiography room. The celiac trunk was catheterized and a microcatheter was advanced into segmental hepatic artery branches which supplied the HCC. The 5cc 0.125 mg/cc ICG was injected from super-selective hepatic artery in operative room. A Near-Infrared laparoscope was used to detect the fluorescent signal to assess the correspondence between arterial-based fluorescence demarcation and ultrasound-based surgical demarcation.
Primary Outcome Measure Information:
Title
Fluorescent hepatic segment demarcation area
Description
The surface size of fluorescent enhanced hepatic segment were measured as cm x cm .
Time Frame
intra-operative period
Title
the rate of fluorescent demarcation corresponding to US guide resection area
Description
The evaluation of the fluorescent hepatic surface which is included in the resected area or not
Time Frame
intra-operative period
Title
The minimal distance between tumor and fluorescent margin
Description
The distance between tumor edge and fluorescent parenchyma edge was measured as cm. This purpose was to evaluation the oncologic safety if the resection line is following the fluorescent margin
Time Frame
intra-operative period
Title
The minimal surgical margin
Description
The distance between tumor edge and resected parenchyma edge was measured as cm.
Time Frame
intra-operative period
Title
surgical benefit rate of fluorescent image
Description
If the fluorescent enhanced area is similar to resected parenchyma or the information of fluorescent image change the primary surgical plan, it was indicated benefit for surgery.
Time Frame
intra-operative period
Secondary Outcome Measure Information:
Title
Post operative complication
Description
any complication related to surgery
Time Frame
one months after operation
Title
Post operative angiography procedure complication
Description
any complication related to angiography procedure
Time Frame
one months after operation
Title
Post operative hospital stay
Description
The day in hospital after operation
Time Frame
one months after operation
Title
Post operative Mortality
Description
any mortality related to surgery
Time Frame
any complication related to surgery
10. Eligibility
Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Single Hepatocellular carcinoma.
plan of Laparoscopic hepatectomy.
Age between 20 to 85 y/o.
Exclusion Criteria:
allergies to iodine or ICG
Liver cirrhosis
coagulopathy
chronic kidney disease
pregnancy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yu-Yin Liu, MD
Organizational Affiliation
Chang Gung Memorial Hospital
Official's Role
Study Director
Facility Information:
Facility Name
Chang Gung Memorial Hospital
City
Niaosong
State/Province
Kaohsiung
ZIP/Postal Code
833
Country
Taiwan
12. IPD Sharing Statement
Plan to Share IPD
No
IPD Sharing Plan Description
due to special technique, data is unique and difficult to fit with other study
Citations:
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Citation
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Arterial Base Fluorescence Segmental Positive Staining
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