Annals of Surgical Oncology

, Volume 24, Issue 4, pp 1046–1047

Laparoscopic Glissonean Pedicle Transection (Takasaki) for Negative Fluorescent Counterstaining of Segment 6

  • Takashi Mizuno
  • Rahul Sheth
  • Masakazu Yamamoto
  • Hyun Seon C. Kang
  • Suguru Yamashita
  • Thomas A. Aloia
  • Yun Shin Chun
  • Jeffrey E. Lee
  • Jean-Nicolas Vauthey
  • C. Conrad
Hepatobiliary Tumors

DOI: 10.1245/s10434-016-5721-2

Cite this article as:
Mizuno, T., Sheth, R., Yamamoto, M. et al. Ann Surg Oncol (2017) 24: 1046. doi:10.1245/s10434-016-5721-2
  • 103 Downloads

Abstract

Background

The portal pedicles are wrapped in connective tissue known as the Walaeus sheath, which abut Laennec’s capsule covering the liver parenchyma. Precise knowledge of this anatomic relationship allows for dissection of this interspace and early control of the segmental portal pedicle (Glissonean pedicle transection method [GPTM], Takasaki approach).1,2 Subsequent systemic administration of indocyanine green (ICG) leads to negative counterstaining of the segment to be resected.

Patient

The patient was a 60-year-old healthy woman with invasive lobular breast cancer, grade 2, which was estrogen receptor-positive (ER +), progesterone receptor-positive (PR +), human epidermal growth factor-negative (HER2–), Ki-67 80%, and cT2N0M1. A synchronous solitary liver metastasis between segments 6 and 7 was diagnosed. After treatment with letrozole and palbociclib for 1 year had achieved stable disease, the patient was considered for liver metastasectomy.3,4

Methods

After an intraoperative ultrasound, the patient was placed in the French position,5 and the gallbladder was disconnected from the cystic duct for exposure of the hepatoduodenal ligament. The hilar plate was lowered, and the portal pedicle of segment 6 was dissected out using the GPTM approach. After test-clamping, an appropriate demarcation was observed, and ICG was administered systemically. This led to negative counterstaining of segment 6 and allowed for precise anatomic dissection under near-infrared vision.

Conclusions

Laparoscopic application of GPTM facilitates anatomically precise liver resection through early pedicle control. Negative counterstaining using ICG under near-infrared vision leads to visual enhancement of the anatomically precise borders. They typically do not follow straight lines and are therefore difficult to dissect precisely. Counterstaining with ICG shows patient-specific anatomic variations that would be a challenge to determine, especially laparoscopically.

Supplementary material

10434_2016_5721_MOESM1_ESM.mp4 (224.4 mb)
Supplementary material 1 (MP4 229775 kb)

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Takashi Mizuno
    • 1
    • 5
  • Rahul Sheth
    • 2
  • Masakazu Yamamoto
    • 4
  • Hyun Seon C. Kang
    • 3
  • Suguru Yamashita
    • 1
  • Thomas A. Aloia
    • 1
  • Yun Shin Chun
    • 1
  • Jeffrey E. Lee
    • 1
  • Jean-Nicolas Vauthey
    • 1
  • C. Conrad
    • 1
    • 6
  1. 1.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Interventional RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Diagnostic RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Institute of GastroenterologyTokyo Women’s Medical UniversityTokyoJapan
  5. 5.Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  6. 6.Department of Surgical Oncology, Hepato-Pancreato-Biliary SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations