Laparoscopic Anatomical Segment 5 Resection for Hepatocellular Carcinoma Using the Glissonian Approach with Indocyanine Green Dye Fluorescence and Ultrasound guidance

Abstract

Background Laparoscopic hepatectomy requires precise techniques for safe completion. We have developed flow and modular strategies using visualization technology to improve surgical outcomes. Methods Between January 1, 2020, and January 1, 2022, 26 patients with tumors in segment 5 underwent Laparoscopic anatomical segment V resection at our institute using real-time ICG fluorescence mapping and ultrasound guidance. Their perioperative course and operative techniques were reviewed retrospectively. Result No cases required open surgery. Blood loss ranged from 10–600 ml, with a median operative time of 225 minutes (90–370). 26 out of 26 preoperative 3D simulations were accurately replicated during surgery, resulting in a 100% concordance rate. Postoperative mortality was absent, with 2 patients experiencing complications leading to a major morbidity rate of 4.6% based on the Clavien‒Dindo classification. Liver function remained stable before and after the operation. Conclusion Laparoscopic segment V resection for hepatocellular carcinoma using the Glissonian approach with indocyanine green dye and ultrasound guidance is safe, convenient, and feasible.