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Laparoscopic Anatomical Segment VII Resection for Hepatocellular Carcinoma Using the Glissonian Approach with Indocyanine Green Dye Fluorescence

  • Jun-ming He
  • Zhi-peng Zhen
  • Qing Ye
  • Jia-qiang Mo
  • Gui-hao Chen
  • Jian-xin PengEmail author
Multimedia Article
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Abstract

Background

Many studies confirm that anatomical resection was associated with favorable oncologic outcomes for patients with HCC who had preserved as much of the remnant liver tissue as possible.1,2 In recent years, laparoscopic liver resection has been widely extended from minor resection to complex hepatectomy,3 However, surgery on tumors located in the posterosuperior segment remains a demanding procedure regardless of the extent of resection.4 Laparoscopic anatomical segment VII resection has one of the highest difficulty scores based on the tumor location due to poor accessibility, hard to exposure, and difficulty in obtaining sufficient surgical margins.5,6 Here, we report a totally laparoscopic anatomical VII resection using the Glissonian approach with indocyanine green dye fluorescence.

Methods

A 74-year-old man with a body mass index of 31.9 kg/m2 suffered from HBV-related cirrhosis was admitted to our institution. The preoperative Gd-EOB-DTPA MRI showed a 2.7-cm HCC located in segment VIII. The preoperative AFP is 3431 ng/ml. A true anatomical segmentectomy was performed by using selective occlusion of segment VII Glissonian pedicle, which was identified from the liver hilum. Indocyanine green (ICG) dye demarcation was used as a guidance during parenchymal transection.

Results

The operative time was 270 min with an estimated blood loss of 200 mL. The postoperative course was uneventful. Drainage tube was pulled out on the fourth day. The pathology confirmed the diagnosis of hepatocellular carcinoma and the surgical margin was negative. The patient was discharged on the 8th day after operation.

Conclusions

Totally laparoscopic anatomical segment VII resection is a technically challenging operation. Advanced laparoscopic skills are necessary to complete such a difficult procedure safely. Glissonian approach and ICG fluorescence imaging guide parenchyma resection could be help.

Keywords

Laparoscopic Segment VII resection Glissonian approach Indocyanine green dye fluorescence 

Notes

Funding Information

This study was supported by a grant from the Guangdong Provincial Health and Family Planning Commission (No. A2016069).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2019_4468_MOESM1_ESM.mp4 (475.2 mb)
ESM 1 (MP4 475 mb)

References

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Copyright information

© The Society for Surgery of the Alimentary Tract 2020

Authors and Affiliations

  • Jun-ming He
    • 1
  • Zhi-peng Zhen
    • 1
  • Qing Ye
    • 1
  • Jia-qiang Mo
    • 1
  • Gui-hao Chen
    • 1
  • Jian-xin Peng
    • 1
    Email author
  1. 1.Department of Hepatobiliary SurgeryGuangdong Province Traditional Chinese Medical HospitalGuangzhouPeople’s Republic of China

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