Laparoscopic S7 Hepatectomy with Positive Fluorescence Staining

Summary

The protocol demonstrates that, under laparoscopic ultrasound guidance, the S7 segment of the liver can be successfully stained by puncturing the visceral and diaphragmatic branches of the tumor, facilitating an anatomical hepatectomy of the S7 segment.

Abstract

Laparoscopic liver resection for tumors located in the S7 segment of the liver typically adopts a traditional surgical approach. The main goal of this procedure is to accurately dissect the liver pedicle of the S7 segment. Dissecting the hepatic pedicle of the S7 segment along the hepatic hilum requires a relatively long path within the liver, which increases the risk of losing orientation and potentially injuring the adjacent hepatic pedicle of the S5 and S6 segments, thereby compromising the liver resection plane. A positive staining method was used to directly puncture the corresponding portal vein under ultrasound guidance (commonly for S7 and S8 segments) to specifically color the target liver segment, thereby avoiding extensive resection of the liver parenchyma, and reducing damage to the surrounding healthy liver tissue. However, the positive staining method requires a specific foundation in intraoperative procedures, which can be challenging for surgeons and has a certain learning curve. Currently, technologies such as three-dimensional reconstruction territory analysis, intraoperative ultrasound, and indocyanine green fluorescence imaging are popular and commonly used in laparoscopic liver resection. In this protocol, under laparoscopic ultrasound guidance, the tumor basin was punctured through the visceral and diaphragmatic surfaces of the liver to stain segment S7. Laparoscopic resection of segment S7 within the portal territory anatomic liver was successfully performed, further confirming the feasibility and advantages of positive fluorescence staining in laparoscopic liver resection at this stage.

Introduction

Primary liver cancer is currently the fourth most common malignant tumor and the second leading cause of cancer-related death in China, posing a serious threat to the lives and health of people globally¹. For hepatocellular carcinoma (HCC), surgical resection has long been the primary treatment option. With the advancements in minimally invasive technology, there has been a growing number of reports on laparoscopic anatomical liver resection for treating HCC. For laparoscopic hepatectomy located in various liver segments, including specialized segments (I, IVb, VII, and VIII), relevant studies have shown that this method is safe and effective

Protocol

This protocol followed the guidelines of the Human Research Ethics Committee of the Foshan Fosun Chancheng Hospital. Written informed consent was obtained from patient for participation in this study.

1. Preoperative preparation

1. Patient preparation: The patient was placed in a supine position, with the head elevated and feet lowered and tilted to the left by approximately 30°. General anesthesia was administered, including tracheal intubation. Abdominal disinfection and draping of the surgical area were performed.
2. Trocar layout: A 1.2 cm trocar (observation hole) was inserted after cutting the skin hor....

Results

In this case report, laparoscopic portal territory staining-guided anatomical liver resection of the S7 segment was successfully performed, with positive staining along the diaphragmatic and visceral surfaces (Figure 6 and Figure 7). Resection of a single 1 cm tumor was done. The operative time was 210 min, and intraoperative blood loss was 100 mL. The postoperative hospitalization duration was 7 days, and the patient is still under continuous f.......

Discussion

Currently, liver surgery is entering an era of minimally invasive surgery. There have been reports of anatomical resection of various liver segments in patients with HCC, and the safety of this operation has been verified². Its efficacy in oncology has attracted increasing attention, and the anatomical hepatectomy approach proposed by Shindoh et al. involves complete resection based on tumor-related territory staining⁶. Limited by previous techniques and equipment, only Cou.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Coated Vicryl Plus Antibacterial Suture	Ethicon, Inc.	3650118	The product is suitable for the placement and/or ligation of soft tissues
Color Doppler ultrasound diagnostic scanner	BK Medical	20153251933	intraoperative ultrasound
Disposable laparoscopic puncture device and puncture sheath	Jiangsu Fenghe Medical Equipment Co., Ltd	20182021588	Used for laparoscopic examination and surgical procedures, to puncture the abdominal wall tissue of the human body and establish a working channel for abdominal surgery
Four way curved electron convex array laparoscopic intraoperative probe	BK Medical	20153251933	Used for intraoperative examination and interventional treatment in various laparoscopic surgeries
HAKKO SONOGUIDE PTC NEEDLE	Baguang Trading (Shanghai) Co., Ltd	20172146872	Percutaneous liver bile duct puncture needle
Indocyanine Green for Injection	DANDONG YICHUANG PHARMACEUTICAL	ICP-09018669-1	Assessment of liver reserve function and liver imaging
WECK Hem-o-lok	Teleflex Medical	20143466018	Ligation of blood vessels or tissues