Purpose: Liver resections in severely obese patients (BMI > 35) are related with increased post-operative morbidity. The use of the laparoscopic approach is associated with fewer complications vs open approach. Indocyanine green (ICG) fluorescence has been recently used for tumour identification in laparoscopic liver resections. We describe a total laparoscopic hepatectomy of segment VI using ICG fluorescence guided technique in a severely obese patient. Method: 68 years old male patient was referred to our unit for management of metachronous liver metastases of segment VI. He had undergone open sigmoidectomy three years ago for a pT4aN2a sigmoid adenocarcinoma. Upon diagnosing metachronous metastatic liver disease, five cycles of preoperative chemotherapy were administered with a good response, as reflected by Carcinoembryonic antigen values and radiological assessment (PET-CT and CT abdo). The patient was severely obese (BMI:37) with a post-operative midline hernia. A laparoscopic approach was decided. Material: ICG (2,5 mg) was administered intravenously 24 hrs prior to surgery. In theatre, the patient was placed in a left lateral decubitus position. Initially, an intraoperative U/S was performed. Total laparoscopic resection of segment VI was performed. Liver transection was performed using laparoscopic Cusa, harmonic scalpel, and intermittent Pringle manoeuvre application. Liver resection with clear macroscopically margins was facilitated significantly by ICG fluorescence image-guided for tumour identification. The specimen was removed through the previous midline incision, and the incisional hernia was corrected. The post-operative course was uneventful, and the patient was discharged on the 4th post-operative day. Histopathology confirmed the presence of metastatic colon adenocarcinoma with clear resection margins (R0 resection). Conclusion: The use of image-guided techniques, for intra-operative tumour identification, facilitates the safe performance of laparoscopic liver resections in severely obese patients with good post-operative outcome.