Tan To Cheung. The University of Hong Kong
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 55-year-old gentlemen who had chronic hepatitis B infection. He was found to have a 2cm tumor in the S8 of the liver by contrast CT scan.
His platelet count was only 80×10^9/L. His bilirubin level was 35umol/L, albumin level was 32g/L. The preoperative ICG retention at 15 minutes was 35%.Pure laparoscopic S8 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. Liver parenchymal transection was performed using the energy device and CUSA along middle hepatic vein. S8 pedicle was controlled. Middle hepatic vein and right hepatic vein was exposed.
Result: The operation last for 245 minutes. Blood loss was 500ml and no blood transfusion was required. He resumed diet on the next day and was discharged 5 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 2cm moderately differentiated HCC. 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 monsegment hepatectomy is an option for patients with HCC and poor liver reserve. 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.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80154
Program Number: V198
Presentation Session: Video Loop
Presentation Type: VideoLoop