Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining

This protocol can accurately determine the resection plane of anatomical hepatectomy. Surgeons can conduct right plane resection leisurely using the fluorescence technique under fluorescent guidance in central hepatectomy. After the preoperative preparations, separate the liver parenchyma at one centimeter on the falciform ligament's right side.

Using clips, ligate and transect several segments for Glisson pedicle branches. Next, separate the right anterior hepatic pedicle along the Laennec's capsule and ligate or occlude the right anterior hepatic pedicle. To define the boundary between the right anterior and right posterior sections, inject two milliliters of 1 to 100 diluted ICG peripherally for negative staining.

Then, dissect the liver parenchyma along the right fluorescent border and transect the right anterior hepatic pedicle using a linear stapler after obtaining sufficient space. Separate the middle hepatic vein at the root and transect it using a linear stapler. Under fluorescence tracing, reserve the trunk of the right hepatic vein, transect the V5d and V8d branches of the right hepatic vein and finish resecting the specimens.

To resect segments five and eight, separate the right anterior hepatic pedicle along the Laennec's capsule. Perform a peripheral injection of two milliliters of 1 to 100 diluted ICG for negative staining to define the boundaries between the left, right anterior, and right posterior sections. Then, process the left resection plane, dissect the liver parenchyma along the left fluorescent border, preserve the trunk of the main hepatic vein, and transect the V5v and V8v branches of the main hepatic vein.

After obtaining sufficient space, transect the right anterior hepatic pedicle using a linear stapler. Next, dissect the liver parenchyma along the right fluorescent border, preserve the trunk of the right hepatic vein, transect the V5d and V8d branches of the right hepatic vein, and finish resecting the specimen. Six patients with hepatocellular carcinoma underwent fluorescent laparoscopic central hepatectomy.

Among these, four patients underwent resections of segments four, five, and eight, and two underwent resections of only segments five and eight. The clinical parameters for the six patients are shown. It is important to separate the right anterior hepatic pedicle along the Laennec's capsule, ligate or occlude the right anterior hepatic pedicle.

When there is an inaccurate fluorescent boundary, complete the operation with the help of intraoperative ultrasound and the guidance of important anatomical landmarks, like the MHV or RHV.