Fluorescence-guided laparoscopic hepatectomy with patient-specific 3D virtual reconstruction for pediatric focal nodular hyperplasia: a retrospective study.
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BACKGROUND: Pediatric Focal Nodular Hyperplasia (FNH) presents diagnostic and therapeutic challenges. This study aimed to evaluate the safety and efficacy of a novel integrated approach combining preoperative three-dimensional (3D) modeling with intraoperative indocyanine green (ICG) fluorescence navigation for laparoscopic resection of pediatric FNH. METHODS: We retrospectively analyzed a total of 10 pediatric patients with FNH who were included and underwent laparoscopic hepatectomy using this combined technique between June 2023 and August 2024. Preoperative contrast-enhanced CT/MRI data were used to generate patient-specific 3D liver models for surgical planning. Intraoperatively, ICG fluorescence was utilized for real-time lesion demarcation and margin assessment. Perioperative outcomes data were systematically collected and analyzed. RESULTS: All 10 procedures were successfully completed laparoscopically without conversion. Regarding perioperative safety, no major intraoperative complications occurred. Postoperatively, there were no major complications; minor adverse events were limited to transient, self-limiting elevations of liver enzymes. The mean operative time was 168.3 ± 9.5 min, with a mean estimated blood loss of 115.0 ± 20.0 ml. The mean postoperative hospital stay was 10.6 ± 1.3 days. The 3D models combing with ICG fluorescence can precisely delineated tumor margins, facilitating complete R0 resection in all cases. At 3-month follow-up, all patients exhibited normal liver function with no evidence of residual disease or recurrence. CONCLUSION: The integration of 3D virtual modeling and ICG fluorescence navigation is a safe and highly effective strategy for the laparoscopic management of pediatric FNH.