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Indocyanine-green fluorescence guided anatomical segmentectomy for HCC with portal thrombosis: the counter-fluorescence technique

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Abstract

A surgical technique to intra-operatively define segmental boundaries by US-guided bimanual liver compression has been described by the authors, but this procedure is contraindicated in case of portal tumor thrombus. A technique to overcome this limitation is described. A patient with a single hepatocarcinoma nodule and segment 8 (S8) portal branch thrombosis was submitted to the procedure. Anatomical demarcation of S8 was achieved by hilar clamping of the common hepatic artery, intravenous injection of indocyanine green (ICG), and fluorescence imaging analyses of the liver. The procedure was feasible and the demarcation of S8 was visible within 2 min from the iv injection of ICG in a counterstaining fashion. Then S8 segmentectomy was safely carried out. This novel approach seems feasible, providing a reliably anatomical and conservative removal of HCC with portal branch tumor thrombus.

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Authors and Affiliations

  1. Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital-IRCCS, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, MI, Italy

    Andrea Pansa, Guido Torzilli, Fabio Procopio & Daniele Del Fabbro

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  1. Andrea Pansa
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  2. Guido Torzilli
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  3. Fabio Procopio
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  4. Daniele Del Fabbro
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Correspondence to Guido Torzilli.

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All procedures herein described were in accordance with the ethical standards of the institutional and national research committee and with the Helsinki Declaration and its later amendments or comparable ethical standards.

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Pansa, A., Torzilli, G., Procopio, F. et al. Indocyanine-green fluorescence guided anatomical segmentectomy for HCC with portal thrombosis: the counter-fluorescence technique. Updates Surg 72, 219–222 (2020). https://doi.org/10.1007/s13304-019-00695-4

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  • DOI: https://doi.org/10.1007/s13304-019-00695-4

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