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Indocyanine green fluorescence imaging-guided laparoscopic right posterior hepatectomy

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Abstract

Background

Laparoscopic right posterior hepatectomy is considered difficult on the basis of the surgery difficulty scoring system. In this study, we evaluated the safety and effectiveness of the technical application of indocyanine green (ICG) fluorescence imaging-guided laparoscopic right posterior hepatectomy.

Methods

Twenty-six patients who underwent ICG fluorescence imaging-guided laparoscopic right posterior hepatectomy at Hepatobiliary and Pancreatic Surgery Department of Zhongnan Hospital, Wuhan University, from June 2018 to December 2019, were included. The influence of patient position, trocar placement, hepatic inflow occlusion, central venous pressure (CVP), and the ICG fluorescence imaging-guided method were analyzed.

Results

In 17 patients, the left lateral position was maintained when the main tumor was in the S7, and in the remaining nine patients, the supine position was maintained with the right side of the body raised when the main tumor was in the S6. Ten patients who underwent preoperative injection of ICG were successfully developed for nonanatomical hepatectomy. Sixteen patients received intraoperative ICG injection for anatomical hepatectomy (2 cases had positive imaging findings, 14 cases had negative imaging findings, and 2 cases had failed imaging findings). All patients underwent the Pringle maneuver during the procedure. Four patients were preset with subhepatic vena cava blocking and one patient with suprahepatic inferior vena cava blocking. CVP was controlled at 3.00 ± 0.63 (mean ± SD) cmH2O. The operative time was 216.14 ± 52.05 min, and the bleeding volume was 128.57 ± 75.55 ml. Four patients had Clavien–Dindo level I complications, and one had level III complications. Postoperative hospitalization duration was 6.19 ± 1.40 days. There were 14 patients with hepatocellular carcinoma, 9 with metastatic liver malignancies, 2 with hepatic hemangioma, 1 with focal nodular hyperplasia of the liver, and 10 with hepatitis B liver cirrhosis.

Conclusions

ICG fluorescence imaging guidance could be helpful for the safe implementation of laparoscopic right posterior hepatectomy.

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Acknowledgements

The manuscript was written by all the authors. All authors have given approval for the final version of the manuscript. Li Jinghua and Li Xiaomian contributed to the manuscript equally. This work was supported by the grants from the National Key R&D Program of China (SQ2019YFC200078/02), the Scientific Research Project of the Health Commission of Hubei Province (WJ2017Z007), and the special fund for Basic Scientific Research of Wuhan University (2042019kf0327).

Funding

This work was supported by the Grants from the National Key R&D Program of China (SQ2019YFC200078/02), the Scientific Research Project of the Health Commission of Hubei Province (WJ2017Z007), and the special fund for Basic Scientific Research of Wuhan University (2042019kf0327).

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Author notes

  1. Jinghua Li and Xiaomian Li contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China

    Jinghua Li, Xiaomian Li, Xiao Zhang, Haitao Wang, Kun Li, Yueming He, Zhisu Liu, Zhonglin Zhang & Yufeng Yuan

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  1. Jinghua Li
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Correspondence to Yufeng Yuan.

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Jinghua Li, Xiaomian Li, Xiao Zhang, Haitao Wang, Kun Li, Yueming He, Zhisu Liu, Zhonglin Zhang, and Yufeng Yuan have no conflicts of interest or financial ties to disclose.

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Li, J., Li, X., Zhang, X. et al. Indocyanine green fluorescence imaging-guided laparoscopic right posterior hepatectomy. Surg Endosc 36, 1293–1301 (2022). https://doi.org/10.1007/s00464-021-08404-2

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