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Fluorescence in Liver surgery
Pr Eric Vibert, MD, PhD
Centre Hépato-Biliaire,
Hop. Paul Brousse, Villejuif
Disclosures
• Fees from Bayer, BMS, Johnson&Johnson
• Consultant for Nanobiotix and MID
• Academic collaboration with Echo...
Liver Surgery
Must be feasible Must be useful
Liver Surgery & Transplantation are
the only curatives treatments of
liver cancer
If the patient stays alive after surgery...
Surgical Margins are Crucial
Feasibility of Liver Surgery ?
MELD < 10
MELD < 12
Independant predictive
factor of mortality
Cuccheti et al. Liver Transp...
When I plan a treatment to Mister
Durand, I think to Mister Dupond…
Who will be more beneficiated of
liver transplantation...
The location of HCC is determinant…
LiverSP by SIGHT
Liver Surgery
Must continue to improve
Impact of laparoscopic liver resection in patients with cirrhosis
on post-operative liver failure : A Propensity Score Ana...
Incidence of Post-Operative Liver Failure
Matched-LAP Matched-OPEN
Age (years) 65.3 65.3
BMI (kg/m²) 26.9 26.9
MELD 8.6 8....
Fluorescent Guided Liver Surgery
Ishizawa. Cancer 2009 Ishizawa. Surg Endos 2016Ishizawa. Ann Surg Onc 2010
FluoBeam ® FluoSoft™
Collaboration with Centre Hepato-Biliaire and Fluoptic Company
Provision of Open Device (Fluobeam™) -...
• Indocyanine Green Dye (ICG) – Intravenous injection
• Passive hepatocytes captation and active biliary secretion
• Decre...
100%
40%
30%
iFLOW (ANR Tecsan) (2014-2017)
Coordination : Eric Vibert, Hop. Paul Brousse
Computer modelisation of hemodynamic, histolo...
Indocyanine green processing by the liver
Time in s
Indocyanine green pharmaco-kinetic model
Predict intra-operatively the risk of post-operative liver failure
aims...
26 patients (20 HCC – 6 Colorectal LM) : intraoperative exploration with ICG cam
Only to detect subcapsular lesion / No cl...
170 patients operated by laparotomy for HCC who had received ICG (0.5 mg/kg) at least 48 hours before liver surgery
Intrao...
With the courtesy of T. Ishizawa and M. Terasawa
Intraoperative Pathological Data
Macroscopic Scale and,
in a very next future, at
Microscopic scale…
Conclusions
• Fluorescent guided liver surgery could improved
Certainly, the diagnosis of superficial liver cancer
Probabl...
Golse, Cottin, Vibert et al.
Pessaux et al.
From virtual to real…
Open or Lap
Innovation in Liver Surgery
Innovation in Liver Surgery
Innovation in Liver Surgery
Innovation in Liver Surgery
Innovation in Liver Surgery
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Innovation in Liver Surgery

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Present and futur of Fluorescent Guided Liver Surgery in resection and transplantation. I have made this conference at IFSBM meeting

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Innovation in Liver Surgery

  1. 1. Fluorescence in Liver surgery Pr Eric Vibert, MD, PhD Centre Hépato-Biliaire, Hop. Paul Brousse, Villejuif
  2. 2. Disclosures • Fees from Bayer, BMS, Johnson&Johnson • Consultant for Nanobiotix and MID • Academic collaboration with EchoSens, Fluoptics and IntraSense
  3. 3. Liver Surgery Must be feasible Must be useful
  4. 4. Liver Surgery & Transplantation are the only curatives treatments of liver cancer If the patient stays alive after surgery….
  5. 5. Surgical Margins are Crucial
  6. 6. Feasibility of Liver Surgery ? MELD < 10 MELD < 12 Independant predictive factor of mortality Cuccheti et al. Liver Transpl 2006Farges et al. Ann Surg 2012 Bruix et al. Gastroenterology 1996
  7. 7. When I plan a treatment to Mister Durand, I think to Mister Dupond… Who will be more beneficiated of liver transplantation relatively to resection ? Risk and Interest of oncologic hepatectomy ? VS
  8. 8. The location of HCC is determinant… LiverSP by SIGHT
  9. 9. Liver Surgery Must continue to improve
  10. 10. Impact of laparoscopic liver resection in patients with cirrhosis on post-operative liver failure : A Propensity Score Analysis M. Prodeau, S. Truant, E. Vibert, O. Farges, J.Y. Mabrut, J. Hardwigsen, J.M. Régimbeau, G. Millet, O. Soubrane, R. Adam, D. Cherqui, F.R. Pruvot, E. Boleslawski The ACHBT French Hepatectomy Study Group Oct 2012 – June 2016 6 French HPB Centers 343 Hepatectomies in F3/F4 89 pts by Lap (26%)
  11. 11. Incidence of Post-Operative Liver Failure Matched-LAP Matched-OPEN Age (years) 65.3 65.3 BMI (kg/m²) 26.9 26.9 MELD 8.6 8.5 Platelets (x 1000/mm3) 167 167 ICG (15 min) 15.2 % 15.0 % HVPG (mmHg) 7.9 8.1 LS (kPa) 21.8 21.9 RLV (%) 88.6 87.6 16% in LAP and 32% in OPEN OR 0.31 [0.12-0.78]; p<0.001
  12. 12. Fluorescent Guided Liver Surgery Ishizawa. Cancer 2009 Ishizawa. Surg Endos 2016Ishizawa. Ann Surg Onc 2010
  13. 13. FluoBeam ® FluoSoft™ Collaboration with Centre Hepato-Biliaire and Fluoptic Company Provision of Open Device (Fluobeam™) - No financial interest
  14. 14. • Indocyanine Green Dye (ICG) – Intravenous injection • Passive hepatocytes captation and active biliary secretion • Decrease of the ICG secretion  Decrease of liver function
  15. 15. 100% 40% 30%
  16. 16. iFLOW (ANR Tecsan) (2014-2017) Coordination : Eric Vibert, Hop. Paul Brousse Computer modelisation of hemodynamic, histological and fonctional events after major hepatectomy in pig to optimize of mecanical portal flow modulation
  17. 17. Indocyanine green processing by the liver
  18. 18. Time in s Indocyanine green pharmaco-kinetic model Predict intra-operatively the risk of post-operative liver failure aims to modified liver hemodynamics using mechanical portal flow modulation (Bucur et al… Vibert, Ann Surg 2017) Audebert et al… Vignon-Clementel, J Biomech 2017 Bucur et al… Vibert, Ann Surg 2017
  19. 19. 26 patients (20 HCC – 6 Colorectal LM) : intraoperative exploration with ICG cam Only to detect subcapsular lesion / No clear data on clinical rentability Cancer 2009 HCC : Fluorescent spot CRLM : Fluorescent ring HCC : No functional hepatocytes
  20. 20. 170 patients operated by laparotomy for HCC who had received ICG (0.5 mg/kg) at least 48 hours before liver surgery Intraop. detection of 21 new spots in 19 patients  14 HCC (8.2%) and 7 False-Positive Low specificity in severe cirrhosis
  21. 21. With the courtesy of T. Ishizawa and M. Terasawa
  22. 22. Intraoperative Pathological Data Macroscopic Scale and, in a very next future, at Microscopic scale…
  23. 23. Conclusions • Fluorescent guided liver surgery could improved Certainly, the diagnosis of superficial liver cancer Probably, the liver graft evaluation at the end of LT Perhaps, post-operative courses by decreasing the risk of post-operative liver failure For more questions…eric.vibert.pbr@gmail.fr
  24. 24. Golse, Cottin, Vibert et al. Pessaux et al. From virtual to real… Open or Lap

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