How to Perform Laparoscopic Right Posterior Sectionectomy when the Right Intersectional Plane is not Always Flat

Area of Science:

• Hepatobiliary Surgery
• Surgical Navigation Technologies
• Medical Imaging

Background:

• The right hepatic vein (RHV) is a key landmark in laparoscopic right posterior sectionectomy (LRPS).
• Discrepancies between theoretical and actual surgical planes are common due to anatomical variations, such as ventral Segment VI portal vein branches.
• Precise determination of the intrahepatic transection plane is challenging.

Purpose of the Study:

• To evaluate the safety and feasibility of using indocyanine green (ICG) fluorescence imaging with augmented reality navigation (ARN) for LRPS.
• To address challenges in determining the intrahepatic transection plane in cases with anatomical discrepancies.

Main Methods:

• A 51-year-old male with hepatocellular carcinoma underwent LRPS.
• Three-dimensional (3D) analysis revealed complex segmental anatomy relative to the RHV.
• The procedure involved blocking the right posterior Glissonean pedicle (RPGP) guided by ARN, followed by ICG negative staining to delineate the transection plane.

Main Results:

• The ICG fluorescent boundaries accurately matched the preoperative 3D model.
• The intrahepatic transection plane was successfully guided by fluorescence imaging and ARN.
• The surgery was completed in 415 minutes with 100 ml blood loss, and the patient experienced no complications.

Conclusions:

• ICG fluorescence imaging combined with ARN is safe and feasible for LRPS.
• This combined approach effectively manages irregular right intersectional planes encountered during surgery.