ICG immunofluorescence guided pure laparoscopic right hepatectomy for HCC in patient with cirrhosis

Tan To Cheung, MS. The Universtiy of Hong Kong Queen Mary Hospital

Background: The advantages of laparoscopic liver resection become more obvious as evidence on its long term outcome has emerged. Compared to open resection, there is no difference in term of overall survival. During laparoscopic liver resection, surgeons cannot use their tactile sensation to feel the liver and to evaluate the margin from the tumour. ICG immuofluoresence navigation is a new method to provide a visualisation of the tumor on display screen during the operation.

This video will demonstrate the use of pure laparoscopic right hepatectomy for a patient with right lobe HCCs.

Method: The patient was a 50-year-old gentlemen who had chronic hepatitis B infection. He was found to have a 5cm tumor in the right lobe of the liver and one 1cm suspicious lesion in the S8 of the liver by contrast CT scan.

His platelet count was only 111×10^9/L. His bilirubin level was 25umol/L, albumin level was 37g/L. The preoperative ICG retention at 15 minutes was 8%.

Pure laparoscopic right hepatectomy was performed as shown in the video.

0.5mg/kg of ICG was administrated to patient 1 day before operation. The Tumor and suspected lesions were directly visualized during the procedure. The hepatic right hepatic artery and right portal vein were controlled and divided individually and the right bile duct was divided. Liver parenchymal transection was performed using the energy device and CUSA. The right hepatic vein was divided by vascular stapler. Intracoporal suture was performed to control the bleeding from hepatic vein stump.

Result: The operation last for 280 minutes. Blood loss was 300ml and no blood transfusion was required. He resumed diet on the next day and was discharged 4 days after the operation. He has good liver function before discharge and at 7 days, 1 month and 3 months after operation. The pathology showed a 5cm moderately differentiated HCC in the right lobe, the S8 lesion was a dysplastic nodule. Contrast CT scan was arranged at one month and every three months interval after the operation according to our protocol and no recurrence was found.

Conclusion: Pure laparoscopic right hepatectomy is safe option even for patients with HCC.

The use of ICG immunofluorescence system is a useful adjunct to complicated laparoscopic liver resection. It is sensitive in picking up lesion and aid the surgeons in visualising the lesions without touching it.

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