Technical tips for indocyanine green-guided minimally invasive anatomical liver resection

Abstract

Minimally invasive anatomical liver resection is increasingly feasible due to the improved availability of preoperative 3-dimensional (3D) reconstruction of the liver as well as endoscopic cameras with near-infrared indocyanine green fluorescence overlay visualization. In this article, we share our experience and perceived benefits of anatomical liver resection with preoperative 3D liver reconstruction, provide technical tips to improve success at pedicle isolation and address common pitfalls that may be encountered by adopters early on their learning curve.

Keywords

Anatomic resection / indocyanine green / negative-staining / minimally invasive hepatectomy

References

[1] Wakabayashi G,Geller DA.The Tokyo 2020 terminology of liver anatomy and resections: updates of the Brisbane 2000 system.J Hepatobiliary Pancreat Sci2022;29:6-15

[2] Cho JY,Choi Y.Association of remnant liver ischemia with early recurrence and poor survival after liver resection in patients with hepatocellular carcinoma.JAMA Surg2017;152:386-92 PMCID:PMC5470428

[3] Sun Z,Shi XL,Chen J.Anatomic versus non-anatomic resection of hepatocellular carcinoma with microvascular invasion: a systematic review and meta-analysis.Asian J Surg2021;44:1143-50

[4] Couinaud C. Surgical anatomy of the liver revisited. Paris: Self printed; 1989. pp. 144-145. Available from: https://books.google.com/books/about/Surgical_Anatomy_of_the_Liver_Revisited.html?id=yLh_AAAACAAJ. [Last accessed on 2 Jan 2025].

[5] Lee MJ,Jang JH.Tailored strategy for dissecting the glissonean pedicle in laparoscopic right posterior sectionectomy: extrahepatic, intrahepatic, and transfissural glissonean approaches (with video).World J Surg2022;46:1962-8

[6] Sugioka A,Tanahashi Y.Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec’s capsule: proposal of a novel comprehensive surgical anatomy of the liver.J Hepatobiliary Pancreat Sci2017;24:17-23 PMCID:PMC5299460

[7] Fujiyama Y,Mishima K,Colella M.Latest findings on minimally invasive anatomical liver resection.Cancers2023;15:2218 PMCID:PMC10137136

[8] Kim JH.Novel traction method by STRATAFIX symmetric (pulley maneuver) in laparoscopic hepatectomy.J Gastrointest Surg2023;27:460-3

[9] Choi SH,Han DH.Laparoscopic liver resection using a rubber band retraction technique: usefulness and perioperative outcome in 100 consecutive cases.Surg Endosc2015;29:387-97