Laparoscopic anatomical S7 segmentectomy with ICG fluorescence staining by laparoscopic ultrasound guided portal branch puncture approach

Abstract

Summary: This video demonstrates laparoscopic anatomical S7 segmentectomy with ICG positive staining by laparoscopic ultrasound (US) and 3D visualization guided portal branch puncture approach. Preoperative 3D reconstruction of the tumor and vessels, and simulation of the perfusion area of portal branches were performed. The left lateral position was used. The branche of S7 were identified by laparoscopic US and punctured with the 22-gauge PTCD needle through the abdominal wall under laparoscopic US and 3D visualization image guide. 5mL ICG dye (0.0125 mg/ml) was injected into the portal branch of S7 without clamping inflow. The S7 started to fluoresce after the injection of the ICG. After full mobilization of the right lobe, S7 was exposed very well, and there is adequate space for resection. Liver parenchyma was transected along the fluorescence boundary with Harmonic and CUSA. The intersegmental plane could be indentified clearly during division of the liver parenchyma. The Glissonean pedicles of S7 and the right hepatic vein were exposed on the border of fluorescence. The Glissonean pedicles of S7 and the tributaries of hepatic vein were clipped and transected. This novel technique enables us to clearly identify S7 prior to and during parenchymal transection, also facilitate the regular caudal approach without using intercostal ports.