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Case report: How I do it? Laparoscopic hepatectomy with transcatheter arterial ICG staining for hepatolithiasis
Jingyi Xu1,2, Xinye Qian3, Wei Yang1
1Center of Hepatobiliary Pancreatic Disease, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Insights
Hepatolithiasis (bile duct stones) treatment is challenging. Laparoscopic watershed hepatectomy with fluorescent navigation offers a precise approach for stone removal and preventing recurrence.
Area of Science:
- Hepatobiliary surgery
- Minimally invasive surgery
- Surgical navigation technologies
Background:
- Hepatolithiasis, characterized by intrahepatic bile duct stones, poses significant clinical challenges due to recurrent inflammation and difficulty in complete stone removal.
- Current treatment strategies focus on stone eradication, stenosis correction, and recurrence prevention, yet effective methods remain an area of active research.
Observation:
- A 66-year-old male patient presented with concurrent hepatolithiasis and choledocholithiasis.
- The patient underwent a complex procedure involving selective hepatic arteriography, transcatheter arterial embolization, laparoscopic watershed hepatectomy with fluorescent navigation, and laparoscopic common bile duct exploration for stone removal.
Findings:
- Laparoscopic watershed hepatectomy guided by fluorescent navigation facilitates precision in liver surgery.
- Trans-arterial DSA positive fluorescence navigation, utilizing 3D visual watershed analysis, demonstrates advantages over traditional staining methods.
- This technique successfully overcomes limitations associated with reverse and positive staining methods in visualizing bile duct structures.
Implications:
- Fluorescent navigation in laparoscopic watershed hepatectomy provides crucial support for accurate liver resections.
- The findings suggest potential improvements in surgical outcomes for hepatolithiasis patients.
- This approach offers valuable insights and recommendations for the future of hepatectomy procedures in managing complex bile duct stone disease.
Background:
Hepatolithiasis is regarded as the presence of stones in the intrahepatic bile ducts. Recurrent inflammation of bile ducts can bring many bad effects. How to completely remove stones is still a challenge.
Presentation:
A 66-year-old male went to our hospital because of hepatolithiasis and choledocholithiasis. Selective hepatic arteriography and transcatheter arterial embolization followed by laparoscopic watershed hepatectomy under fluorescent navigation and laparoscopic common bile duct exploration on mass removal are performed.
Clinical Discussion:
For patients who suffer from hepatolithiasis, the main treatment principles of the operation are to remove the stones, correct the stenosis, and prevent recurrence. The laparoscopic watershed hepatectomy under fluorescent navigation can provide important support for precision liver surgery, which can give some suggestions for future hepatectomy.
Conclusion:
Based on the three-dimensional (3D) visual watershed analysis, trans-arterial DSA positive fluorescence navigation has some advantages, which successfully overcome the shortcomings of the reverse staining method and the positive staining method.
