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Laparoscopic Anatomical Extended Right Posterior Sectionectomy Using Virtual Liver Segment Projection Navigation and Indocyanine Green Fluorescence Imaging

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Extended right posterior sectionectomy is an alternative to right hepatectomy (RH) for tumors located mainly in the right posterior section (RPS) and partially in the right anterior section (RAS).1 Anatomical extended right posterior sectionectomy (AERPS) combining RPS and right anterior subsegmental resections not only achieves anatomical hepatectomy to reduce remnant liver ischemia2 but also preserves more functional liver parenchyma than RH. AERPS can be extremely challenging, especially under laparoscopy.

Patient and Methods

A 48-year-old male was admitted to our institution for a tumor in the right liver. The three-dimensional (3D) model revealed that the subsegments innervated by the P5dor and the P8lat could cover the territory of the tumor in the RAS.3 Therefore, laparoscopic AERPS was performed. First, an intrafascial approach was adopted to dissect and ligate the right posterior Glissonean pedicle. Then, we used intraoperative ultrasound and virtual liver segment projection by Laparoscopic Hepatectomy Navigation System4 to identify the intersegmental fissure between the dorsal and ventral segments of S5. Partial parenchymal transection was used to reach the common stem of G5dor and G8lat.5 Finally, using indocyanine green (ICG) negative staining fluorescence imaging, the precise transection interface was determined.

Results

The operation lasted 360 min with 100 ml of intraoperative blood loss. There were no postoperative complications, and the patient was discharged after 3 days.

Conclusion

Laparoscopic AERPS is technically feasible and can be performed with greater precision coupled with virtual liver segment projection and ICG fluorescence imaging.

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References

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Acknowledgements

None.

Funding

This study was supported by the Mathematical Tianyuan Fund of the National Natural Science Foundation of China (Grant No. 12026602), National Major Scientific Instruments and Equipments Development Project of the National Natural Science Foundation of China (Grant No. 81627805), National Natural Science Foundation of China (Grant No. 82272132), Guangdong Basic and Applied Basic Research Foundation (Grant No. 2021A1515011869), the Science and Technology Plan Project of Guangdong Province (Grant No. 2021A1414020003), and Regional Joint Fund of Guangdong (Guangdong-Hong Kong-Macao Research Team Project) (Grant No. 2021B1515130003). The authors declare that they have no conflicts of interest.

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Author notes

  1. Xiaojun Zeng, Wen Zhu, and Wenjun Lin contributed equally to this work as co-first authors.

Authors and Affiliations

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

    Xiaojun Zeng MD, Wen Zhu MD, Wenjun Lin MD, Jian Yang PhD & Chihua Fang PhD

  2. Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China

    Xiaojun Zeng MD, Wen Zhu MD, Wenjun Lin MD, Jian Yang PhD & Chihua Fang PhD

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

    Xiaojun Zeng MD, Wen Zhu MD, Wenjun Lin MD, Jian Yang PhD & Chihua Fang PhD

  4. CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China

    Jie Tian PhD

  5. Pazhou Lab, Guangzhou, China

    Jian Yang PhD & Chihua Fang PhD

Authors
  1. Xiaojun Zeng MD
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  2. Wen Zhu MD
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  3. Wenjun Lin MD
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  4. Jie Tian PhD
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  5. Jian Yang PhD
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  6. Chihua Fang PhD
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Corresponding authors

Correspondence to Jie Tian PhD, Jian Yang PhD or Chihua Fang PhD.

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Zeng, X., Zhu, W., Lin, W. et al. Laparoscopic Anatomical Extended Right Posterior Sectionectomy Using Virtual Liver Segment Projection Navigation and Indocyanine Green Fluorescence Imaging. Ann Surg Oncol 30, 375–376 (2023). https://doi.org/10.1245/s10434-022-12551-8

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  • DOI: https://doi.org/10.1245/s10434-022-12551-8

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