Abstract
Background
Laparoscopic right anterior sectionectomy (LRAS) remains a technically demanding procedure as it requires two transection planes where the middle and right hepatic veins run; however, the main difficulty is locating these two planes1,2,3. The aim of this video was to show the technique of an LRAS performed with a transparenchymal glissonean pedicle approach and guided by indocyanine green (ICG) staining.
Methods
This was the case of an 80-year-old man with a history of hemochromatosis and normal liver function. He was diagnosed with a 6 cm hepatocellular carcinoma (HCC) located at segment 8, close to the right anterior pedicle.
Results
The technique consisted of parenchymal transection along the main portal fissure along the right border of the middle hepatic vein. Opening the liver facilitated access to the right anterior glissonean pedicle and selective transparenchymal clamping. A negative-stain ICG test permitted to demarcate the transection line along the right lateral portal fissure. The parenchymal transection was carried out in a caudal approach, along two perfectly marked planes, preserving the middle and right hepatic veins.
The duration of the procedure was 200 min and blood loss was 300 mL. Postoperative course was uneventful and the patient was discharged on the third postoperative day.
Conclusion
Guidance during resection, and protection of the right posterior pedicle and right hepatic vein are the key points of the LRAS. The glissonean approach and the ICG imaging technology are of great help in resolving these difficulties.
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References
Kim KH, Kim HS, Lee YJ, Park KM, Hwang S, Ahn CS, et al. Clinical analysis of right anterior segmentectomy for hepatic malignancy. Hepatogastroenterology. 2006;53(72):836–9.
Kirchner VA, Kim KH, Kim SH, Lee SK. Pure laparoscopic right anterior sectionectomy for hepatocellular carcinoma with great vascular exposure. Surg Endosc. 2017;31(8):3349–50.
Chen HW, Wang FJ, Li JY, Deng FW, Lai ECH, Lau WY. Extra-glissonian approach for laparoscopic liver right anterior sectionectomy. JSLS. 2019;23(2):e2019.
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Marie Livin, Amine Sebai, Stylianos Tzedakis, Hassene Hajji, Karim Boudjema, and Heithem Jeddou declare no conflicts of interest.
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Livin, M., Sebai, A., Tzedakis, S. et al. Combination of a Glissonean Approach and Indocyanine Green Fluorescence Imaging to Perform a Laparoscopic Right Anterior Sectionectomy. Ann Surg Oncol 31, 4030 (2024). https://doi.org/10.1245/s10434-024-15151-w
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DOI: https://doi.org/10.1245/s10434-024-15151-w