The device of hepatic subsegment identification which aimed at pure laparoscopic hepatectomy

Masahiko Sakoda, MD, Shinichi Ueno, MD, Satoshi Iino, MD, Koji Minami, MD, Kei Ando, MD, Yota Kawasaki, MD, Motoyuki Hashiguchi, MD, Hiroshi Kurahara, MD, Yukou Mataki, MD, Kousei Maemura, MD, Hiroyuki Shinchi, MD, Shoji Natsugoe, MD, Shinichirou Mori, MD

Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine

Introduction: It is important to minimize surgical invasiveness in the therapy of patients with hepatocellular carcinoma (HCC) and, consequently, laparoscopic hepatic resection is widely performed. However, most anatomic resections, except left lateral sectionectomy, are still difficult technically and, as an alternative approach, laparoscopy-assisted procedures also have been introduced because of the safety and curative success of the operation. When considering pure laparoscopic subsegmentectomy or segmentectomy, it seems that two issues may become problematic: the identification of the subsegment or segment and securing the parenchymal transection line. In parenchymal transection of the liver, a safe laparoscopic procedure can be developed using new instruments and devices. On the other hand, although there is a procedure of closing the Glisson’s pedicle in order to determine the transection line, this is technically difficult in a purely laparoscopic operation. Herein, we describe two cases of pure laparoscopic subsegmentectomy of the liver using puncture of the portal branch under percutaneous ultrasound (PUS) with injection of blue dye, and under laparoscopic ultrasound (LUS) with injection of indocyanine green (ICG).
Case 1: The identification of the subsegment was performed by blue dye injection under PUS guidance with artificial ascites. Pure laparoscopic subsegmentectomy of segment 6 was completed successfully and the postoperative course was uneventful. Case 2: The identification of the subsegment was performed by ICG injection for optical imaging using near-infrared fluorescence (NIR) under LUS guidance. Pure laparoscopic subsegmentectomy of segment 5 was completed successfully and the postoperative course was uneventful.
Conclusions: Pure laparoscopic subsegmentectomy for HCC with a conventional puncture technique under PUS with artificial ascites or under LUS using NIR by ICG injection is considered to be a useful procedure featuring both low invasiveness and curative success.

Session: Poster Presentation

Program Number: P335