Precise Anatomical Resection of the Left Lateral Section Using Extrahepatic Glissonean Approach and Fluorescence...

Area of Science:

• Hepatobiliary surgery
• Surgical anatomy
• Minimally invasive techniques

Background:

• Anatomical liver resection offers oncological benefits and may reduce complications.
• Conventional left lateral sectionectomy (LLS) landmarks can be obscured by portal umbilicus branches (P4dor).
• A novel LLS technique is proposed using an extrahepatic Glissonean approach and indocyanine green (ICG) fluorescence.

Purpose of the Study:

• To investigate the P4dor territory using CT imaging.
• To assess the safety and efficacy of a novel LLS technique.
• To evaluate the feasibility of ICG fluorescence for P4dor delineation.

Main Methods:

• Analysis of 128 patients' dynamic computed tomography images.
• Application of the novel LLS technique in robotic, laparoscopic, and open surgery.
• Isolation of Glissonean pedicles, P4dor boundary delineation under ICG guidance, and parenchyma transection.

Main Results:

• P4dor was identified in 91.4% of cases with a mean of 1.4 branches.
• The P4dor territory had a mean annular volume of 21.7 ml.
• The novel technique clearly delineated and preserved P4dor boundaries in all surgical cases, with no postoperative complications.

Conclusions:

• The proposed LLS technique is simple, feasible, and reproducible for minimally invasive surgery.
• ICG fluorescence effectively clarifies P4dor demarcation for anatomical resection.
• This approach may improve margins in biliary tumors while preserving functional liver parenchyma.