Indocyanine green fluorescence navigation for anatomical laparoscopic segment 6 hepatectomy

Abstract

Purpose: To show the role of indocyanine green (ICG) fluorescence navigation in laparoscopic hepatectomy and its intraoperative influence for anatomical liver resection. Methods: This procedure was performed on a 67-year-old man with a 5 cm sized hepatocarcinoma mass in the segment 6. The CT scan showed the pedicle of the segment 6. We planned the intraoperative identification of the 6 pedicle thought ultrasound, checking its correct identification using the ICG. Results: After creation of a pneumoperitoneum via a 12 mm infra-umbilical port, 5 additional trocars are inserted. As showed in the video, surgery is started with laparoscopic ultrasound and identification of the pedicle of the 6 segment that is finally dissected. We injected ICG intravenously before and after clamping the segment 6 pedicle. The liver was observed under visible light and under near-infrared light showing the lack of perfusion of segment 6, assuring the correct identification of its pedicle. Thereafter, the liver segment is resected following the ICG margins. Conclusions: ICG fluorescence navigation is safe and efficient in laparoscopic hepatectomy. It helps to better identify liver segment pedicles assuring surgical margins.