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Double cone-unit laparoscopic hepatic resection using indocyanine green negative counterstaining (with video)

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Abstract

A hepatic cone-unit represents an anatomical unit dominated by a smaller Glissonean pedicle. Anatomical resection of a tumor located in an intersegmental plane is challenging, but could be achieved effectively by performing multiple cone-unit resection. We performed double cone-unit laparoscopic resection of hepatocellular carcinoma located on the intersegmental plane between segments 6a, b. The liver parenchyma covering the posterior Glissonean pedicle was divided along Rouviere’s sulcus, the Glissonean branches of segments 6a, b were isolated and ligated, and indocyanine green (ICG) negative counterstaining was performed. The hepatic parenchyma was dissected along the demarcation line to identify the right hepatic vein and the double cone-unit resection was then completed with a negative surgical margin. Thus, double cone-unit laparoscopic hepatectomy with ICG negative counterstaining may be a feasible option for tumors located in an intersegmental plane.

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Abbreviations

G6a:

Glissonean branch for segment 6a

ICG:

Indocyanine green

G6b:

Glissonean branch for segment 6b

RHV:

Right hepatic vein

S6a:

Segment 6a

S6b:

Segment 6b

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Mishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Jungo Yasuda, Koichiro Haruki, Kenei Furukawa, Shinji Onda, Yoshihiro Shirai, Takeshi Gocho & Toru Ikegami

Authors
  1. Jungo Yasuda
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  2. Koichiro Haruki
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  3. Kenei Furukawa
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  4. Shinji Onda
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  5. Yoshihiro Shirai
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  6. Takeshi Gocho
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  7. Toru Ikegami
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Corresponding author

Correspondence to Toru Ikegami.

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We have no conflicts of interest to report. The manuscript was not prepared or funded by a commercial organization. The present study was approved by the Institutional Ethics Committee of The Jikei University School of Medicine (Registration Number 27–177) and conformed to the ethical guidelines of the Declaration of Helsinki.

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Yasuda, J., Haruki, K., Furukawa, K. et al. Double cone-unit laparoscopic hepatic resection using indocyanine green negative counterstaining (with video). Surg Today 51, 1881–1885 (2021). https://doi.org/10.1007/s00595-021-02299-1

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  • DOI: https://doi.org/10.1007/s00595-021-02299-1

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