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Indocyanine green fluorescence image-guided laparoscopic anatomical S2/3 resection using the TICGL technique

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Abstract

Background

Segment 2/3 (S2/3) resection, which can preserve more residual liver parenchyma, is a feasible alternative to left lateral sectionectomy. However, it is still challenging to perform anatomical S2/3 resection safely and precisely, especially laparoscopically. This study was designed to evaluate the safety and accuracy of the temporary inflow control of the Glissonean pedicle (TICGL) technique combined with indocyanine green (ICG) fluorescence imaging in laparoscopic anatomical S2/3 resection.

Patients and methods

A total of 12 patients recruited at Zhujiang Hospital of Southern Medical University from June 2021 to August 2022 were included in the study. All patients underwent ICG fluorescence imaging guided laparoscopic anatomical S2/3 resection. The TICGL technique was used to control the blood inflow of the target segment. The total time used to control the hepatic inflow of the target segment, the time of hemostasis, the amount of intraoperative blood loss, predicted resected liver volume (PRLV) and actual resected liver volume (ARLV) were used to evaluate the simplicity, safety, and accuracy of the TICGL technique combined ICG fluorescent imaging in guiding laparoscopic anatomical S2/3 resection.

Results

Of the 12 included patients, 7 underwent S2 resection and 5 underwent S3 resection. The operation time was 76.92 ± 11.95 min, the intraoperative blood loss was 15.42 ± 5.82 ml, and the time of hepatic blood inflow control was 7.42 ± 2.43 min. There was a strong correlation between PRLV and ARLV (r = 0.903, P < 0.05).

Conclusion

The combination of the TICGL technique with ICG negative staining fluorescence imaging is a feasible approach for laparoscopic anatomical S2/3 resection.

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Funding

This study was supported by the National Natural Science Foundation of China (Grant No. 82272132), China Postdoctoral Science Foundation (Grant No. 2022M721514); Guangdong Basic and Applied Basic Research Foundation (Grant No. 2021A1515011869), the Science and Technology Plan Project of Guangdong Province (Grant No. 2021A1414020003), Regional Joint Fund of Guangdong (Guangdong-Hong Kong-Macao Research Team Project) (Grant No. 2021B1515130003), Key Research and Development Plan Project of Guangzhou (Grant No. 2023B03J1246), and President's Fund of Zhujiang Hospital (Grant No. yzjj2022qn31).

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Author notes

  1. Wenjun Lin, Xinci Li and Zhuangxiong Wang have contributed equally to this work as co-first authors.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China

    Wenjun Lin, Xinci Li, Zhuangxiong Wang, Haisu Tao, Chihua Fang & Jian Yang

  2. Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China

    Wenjun Lin, Xinci Li, Zhuangxiong Wang, Haisu Tao, Chihua Fang & Jian Yang

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  1. Wenjun Lin
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Correspondence to Haisu Tao, Chihua Fang or Jian Yang.

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Wenjun Lin, Xinci Li, Zhuangxiong Wang, Haisu Tao, Chihua Fang and Jian Yang have no conflicts of interest or financial ties to disclose.

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Lin, W., Li, X., Wang, Z. et al. Indocyanine green fluorescence image-guided laparoscopic anatomical S2/3 resection using the TICGL technique. Surg Endosc 38, 1069–1076 (2024). https://doi.org/10.1007/s00464-023-10633-6

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  • DOI: https://doi.org/10.1007/s00464-023-10633-6

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