Identification of the Liver Anatomy During Open Hepatectomy

Abstract

Indocyanine green (ICG) fluorescent imaging is one of the most effective techniques to identify the hepatic anatomy during surgery and to assure accurate and safe hepatic resection. It can help surgeons identify the hepatic anatomical boundaries and bile duct anatomy at the hepatic hilum during hepatectomy. A systemic injection of ICG allows surgeons to visualize the anatomical boundaries after a segmental hepatic inflow occlusion. Contrary to the visualization of the ischemic area on the liver surface with a naked eye, ICG fluorescent imaging helps visualize the hepatic boundaries not only on the liver surface but also inside the hepatic parenchyma. Another application of the ICG fluorescent imaging is intraoperative cholangiography. It illuminates the bile duct with the injection of diluted ICG. After parenchymal resection around the hepatic hilum and before dissecting the hepatic duct during hemi-hepatectomy, diluted ICG is administrated directly into the cystic duct, thus illuminating the hepatic duct during ICG fluorescent imaging examination. Both techniques can enhance the safety of hepatectomy.