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ICG-Enhanced Compression Anatomical Segment 7 Segmentectomy in Laparoscopic and Robotic Approach
Fabio Procopio1,2, Giulia Mauri1, Flavio Milana1
1Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, Milan, Italy.
Annals of Surgical Oncology
|March 23, 2024
Summary
This study introduces a new minimally invasive anatomical resection (AR) technique for liver segment 7 (S7) tumors using compression and indocyanine green (ICG) fluorescence. The technique proved feasible and reliable in laparoscopic and robotic surgeries for hepatocellular carcinoma (HCC).
Area of Science:
- Hepatobiliary surgery
- Minimally invasive surgical techniques
- Oncology
Background:
- Minimally invasive anatomical resection (AR) for posterosuperior liver lesions is challenging.
- The Glissonean approach and puncture techniques are common alternatives.
- Tumor-feeding portal pedicle compression AR (C-AR) is established in open surgery, enhanced by indocyanine green (ICG) fluorescence.
Purpose of the Study:
- To report the first cases of laparoscopic and robotic segment 7 (S7) segmentectomy using ICG-enhanced compression anatomical resection (C-AR).
- To evaluate the feasibility and reliability of this novel technique for posterosuperior liver lesions.
Main Methods:
- Two CHILD-class A hepatocellular carcinoma (HCC) patients underwent laparoscopic and robotic anatomical S7 segmentectomies.
- Intraoperative ultrasound (IOUS) guided compression of the S7 Glissonean pedicle.
- Intravenous ICG administration enhanced visualization of the target resection area.
Main Results:
- Successful R0 resection margins (>1 cm) were achieved for HCCs measuring 4.9 cm and 7.3 cm.
- No postoperative complications were observed.
- Patients were discharged within 6 days after surgery.
Conclusions:
- ICG-enhanced C-AR is a feasible and reliable technique for laparoscopic and robotic approaches to posterosuperior liver lesions.
- Further research is required to standardize and explore the broader applicability of this technique.
