Related Experiment Video
Updated: Sep 8, 2025
03:23
Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining
Published on: March 17, 2023
869
Cone Unit-Based Anatomical Liver Resection Guided by Preoperative Embolization and ICG Fluorescence: A Novel Surgical
Fumihiro Kawano1,2, Megan A Lim1, Helen J Kemprecos1
1Carle Illinois College of Medicine University of Illinois Urbana-Champaign, 509 W University Ave, Urbana, IL, 61801, USA.
Annals of Surgical Oncology
|September 6, 2025
Summary
Precise liver surgery is now possible for patients with cirrhosis using a novel cone unit resection technique. This approach combines radiology and surgery for accurate tumor removal, preserving liver function with minimal blood loss.
Area of Science:
- Hepatobiliary surgery
- Interventional radiology
- Surgical oncology
Background:
- The liver cone unit is the smallest anatomical and functional liver unit.
- Identifying the tumor-bearing cone unit intraoperatively is challenging, especially in patients with cirrhosis.
- Standard resection or ablation may be difficult due to tumor location and patient condition.
Purpose of the Study:
- To present a novel combined interventional radiology and surgical approach for precise anatomical liver resection based on the cone unit.
- To demonstrate the feasibility of cone unit resection in a patient with advanced cirrhosis and hepatocellular carcinoma.
- To highlight a technique for overcoming intraoperative localization challenges in cirrhotic livers.
Main Methods:
- Preoperative 3D reconstruction to identify the tumor-bearing cone unit.
- Selective artery embolization of the feeding artery of the adjacent cone unit.
- Intraoperative Indocyanine Green (ICG) injection into the tumor-bearing cone unit for fluorescence guidance.
- Laparoscopic anatomical resection along the cone unit boundaries.
Main Results:
- Accurate localization and resection of the tumor-bearing cone unit were achieved.
- The technique allowed for precise anatomical transection with minimal bleeding, despite impaired ICG uptake due to cirrhosis.
- Successful function-preserving hepatectomy was performed in a patient with advanced cirrhosis.
Conclusions:
- A novel combined interventional radiology/surgical approach enables precise cone unit resection.
- This technique offers a solution for challenging intraoperative localization in patients with advanced cirrhosis.
- The method leads to minimal blood loss and preserves liver function during hepatectomy.
