关键词: 吲哚菁绿, 腹腔镜, 解剖性肝切除, 肝细胞癌

Abstract:

Applications of indocyanine green fluorescence imaging in laparoscopic anatomical segmentectomy        WANG Hong-guang. Department of Hepatobiliary Surgery，Hainan Branch of Chinese PLA General Hospital，Sanya 572013，China
Abstract    Laparoscopic anatomical segmentectomy based on the portal territory has become an established procedure for hepatic malignancies. Various landmark techniques have been developed in laparoscopic anatomical segmentectomy，such as the ultrasound-guided or direct dye injection into the target portal branch and the haptic vascular occlusion-induced ischemic demarcation. Given the fact that the intersegmental plane of the liver is not flat，the parenchymal transection plane has to be determined on the basis of landmark vessels and surgeon’s educated guesswork，which is technically demanding and not always precise. The indocyanine green fluorescence imaging offers a potential solution by attaining a strong and real-time contrast visible on the intersegmental plane. The intraparenchymal fluorescent navigation makes it possible to perform an anatomical resection precisely based on the portal territory. ICG dye was injected into the target portal branch (positive staining) or administered intravenously after occluding the target portal pedicle (negative staining). Based on our initial experience，positive staining is technically more suitable to segmentectomy or sub-segmentectomy. Negative staining is suggested for sectionectomy or hemi-hepatectomy. The portal pedicles of hemi-liver or section can be exposed through the Glissonean pedicle dissection. The indocyanine green fluorescence imaging is safe and technically feasible in laparoscopic anatomical segmentectomy. With 3D interactive quantitative surgical planning and guidance of laparoscopic ultrasound，it could become an established fashion in laparoscopic liver surgery. Further studies regarding its oncological outcomes are necessary in larger prospective cohorts.

Key words: indocyanine green fluorescence, laparoscopy, anatomical liver resection, hepatocellular carcinoma