Indocyanine green fluorescence for intraoperative detection of liver tumours in minimally invasive surgery: protocol for the LIVERGREEN phase IV multicentre clinical trial


Por: Huerta, M, Lopez-Ben, S, Lladó, L, Sánchez-Cabús, S, Mils, K, Molina, V, Dopazo, C, Vidal, L, Dalmau, M, Caralt, M, Rosón, N, Merino, X, Armario, D, Salcedo, MT, Pellino, G, Sapisochin, G, Gómez-Gavara, C

Publicada: 16 abr 2026
Resumen:
Introduction Liver tumours are a leading cause of global morbidity and mortality. Current diagnostic tools, including computed tomography (CT), magnetic resonance imaging (MRI) and intraoperative ultrasound (IOUS), have limitations in detecting liver neoplasms. Indocyanine green (ICG) has emerged as a promising tool for improving liver tumour detection. This study aims to assess the impact of preoperative ICG on intraoperative tumour detection in minimally invasive surgery and develop a machine-learning algorithm to enhance tumour detection using ICG fluorescence.Methods and analysis This prospective, multicentre, phase IV clinical trial adheres to Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. Patients with liver tumours eligible for minimally invasive surgery and a preoperative imaging test will be included. ICG will be administered intravenously 24 hours before surgery. Intraoperative procedures will include IOUS, ICG mapping and photographic documentation. Patients will be followed for 90 days to assess tumour progression, morbidity and mortality. The photographic analysis will enable the development of an artificial intelligence algorithm using machine learning and neural networks to identify lesions based on ICG fluorescence. The estimated sample size is 173 patients and the trial is predicted to accrue in 3 years.Ethics and dissemination The trial will be conducted in accordance with the Declaration of Helsinki and the Spanish Agency of Medicines and Medical Devices (AEMPS) guidelines. Approved by the local institutional Ethics Committee and the AEMPS, the results will be shared with the scientific community through publications and conferences.EudraCT number 2023-5 08 316-27-00.Trial registration number NCT06398028.Protocol version V.12, 18 March 2025

Filiaciones:
Huerta, M:
 Vall Hebron Univ Hosp, Dept Gen & Digest Surg, HPB Surg & Liver Transplant Unit, Barcelona, Spain

 Univ Autonoma Barcelona, Barcelona, Spain

Lopez-Ben, S:
 Hosp Univ Girona Doctor Josep Trueta, HPB Surg Unit, Girona, Spain

Lladó, L:
 Bellvitge Univ Hosp, HPB Surg & Liver Transplant Unit, Lhospitalet De Llobregat, Spain

 Univ Barcelona, Barcelona, Spain

Sánchez-Cabús, S:
 Univ Autonoma Barcelona, Barcelona, Spain

 Hosp Santa Creu & Sant Pau, HPB Surg Unit, Barcelona, Spain

Mils, K:
 Bellvitge Univ Hosp, HPB Surg & Liver Transplant Unit, Lhospitalet De Llobregat, Spain

 Univ Barcelona, Barcelona, Spain

Molina, V:
 Univ Autonoma Barcelona, Barcelona, Spain

 Hosp Santa Creu & Sant Pau, HPB Surg Unit, Barcelona, Spain

Dopazo, C:
 Vall Hebron Univ Hosp, Dept Gen & Digest Surg, HPB Surg & Liver Transplant Unit, Barcelona, Spain

 Univ Autonoma Barcelona, Barcelona, Spain

Vidal, L:
 Vall Hebron Univ Hosp, Dept Gen & Digest Surg, HPB Surg & Liver Transplant Unit, Barcelona, Spain

 Univ Autonoma Barcelona, Barcelona, Spain

Dalmau, M:
 Vall Hebron Univ Hosp, Dept Gen & Digest Surg, HPB Surg & Liver Transplant Unit, Barcelona, Spain

 Univ Autonoma Barcelona, Barcelona, Spain

Caralt, M:
 Vall Hebron Univ Hosp, Dept Gen & Digest Surg, HPB Surg & Liver Transplant Unit, Barcelona, Spain

 Univ Autonoma Barcelona, Barcelona, Spain

Rosón, N:
 Univ Autonoma Barcelona, Barcelona, Spain

 Vall Hebron Univ Hosp, Dept Radiol, Barcelona, Spain

Merino, X:
 Univ Autonoma Barcelona, Barcelona, Spain

 Vall Hebron Univ Hosp, Dept Radiol, Barcelona, Spain

Armario, D:
 Univ Autonoma Barcelona, Barcelona, Spain

 Vall Hebron Univ Hosp, Dept Radiol, Barcelona, Spain

Salcedo, MT:
 Univ Autonoma Barcelona, Barcelona, Spain

 Vall Hebron Univ Hosp, Dept Pathol, Barcelona, Spain

Pellino, G:
 Univ Autonoma Barcelona, Barcelona, Spain

 Vall Hebron Univ Hosp, Dept Gen & Digest Surg, Colorectal Surg Unit, Barcelona, Spain

Sapisochin, G:
 Vall Hebron Univ Hosp, Dept Gen & Digest Surg, HPB Surg & Liver Transplant Unit, Barcelona, Spain

 Univ Autonoma Barcelona, Barcelona, Spain

Gómez-Gavara, C:
 Vall Hebron Univ Hosp, Dept Gen & Digest Surg, HPB Surg & Liver Transplant Unit, Barcelona, Spain

 Univ Autonoma Barcelona, Barcelona, Spain
ISSN: 20446055





BMJ Open
Editorial
BMJ PUBLISHING GROUP, BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND, Reino Unido
Tipo de documento: Article
Volumen: 16 Número: 4
Páginas:
WOS Id: 001743027100001
ID de PubMed: 41991264
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