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Indocyanine green fluorescence staining based on the “hepatic pedicle first” approach during laparoscopic anatomic liver resection

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Abstract

Background

Indocyanine green (ICG) fluorescence staining is one of the most challenging procedures for laparoscopic anatomic liver resection (LALR). Here, we introduce a novel method based on the “hepatic pedicle first” approach that can improve the success rate of positive staining.

Method

The target hepatic pedicle (even for the subsegment) was dissected through the first porta until it became visible. Five milliliters of 0.025 mg/ml ICG was injected after the target hepatic pedicle (extra-Glissonian approach) or portal vein/hepatic artery (intra-Glissonian approach) was punctured successfully using scalp acupuncture under direct vision. Then, the Glissonian pedicle or vessel was clamped immediately to prevent the intrahepatic diffusion of ICG. During the operation, a fluorescence imaging model was used repeatedly to confirm the segmental boundary.

Results

Finally, 24 patients underwent LALR with the “hepatic pedicle first” approach for ICG fluorescence-positive staining. In 5 patients, ICG-positive staining failed, representing a 79.17% success rate. The average staining time was 25.92 min ± 14.64 min. There were no complications associated with vessel puncture (bile leakage, hemorrhage, and thrombosis).

Conclusion

The “hepatic pedicle first” approach is a feasible, convenient, and safe method for ICG-positive staining, with a high success rate.

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Acknowledgements

We thank Dr. Yan Ma (Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University) for the assistance of data collection.

Funding

This study is supported by grants from the Natural Science Foundation for Young Scientists of Gansu Province and the Science & Technology Planning Project of Gansu Province (Grant No.: 18JR3RA058).

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, The First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, China

    Xiang Lan, Kai Chen & Chengyou Du

  2. Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10# Changjiangzhilu Daping, Yuzhong District, Chongqing, 400042, China

    Yongliang Tang, Wanjie Wei, Ke Jiang & Hongming Liu

  3. Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu Province, People’s Republic of China

    Xiangyong Hao

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  1. Xiang Lan
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Contributions

XL and YT performed the operation of all patients and finished this manuscript; XH, KC, WW, and KJ performed the follow-up of all patients; CD and HL revised this article and participated in the research design and preparation of the paper.

Corresponding authors

Correspondence to Xiangyong Hao or Hongming Liu.

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Disclosure

Xiang Lan, Yongliang Tang, Wanjie Wei, Ke Jiang2 Kai Chen, Chengyou Du, Xiangyong Hao, and Hongming Liu have no conflicts of interest or financial ties to disclose.

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Lan, X., Tang, Y., Wei, W. et al. Indocyanine green fluorescence staining based on the “hepatic pedicle first” approach during laparoscopic anatomic liver resection. Surg Endosc 36, 8121–8131 (2022). https://doi.org/10.1007/s00464-022-09237-3

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  • DOI: https://doi.org/10.1007/s00464-022-09237-3

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