Indocyanine Green Compression Technique for Anatomical S8 Dorsal Subsegmentectomy for Hepatocellular Carcinoma.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
08
12
2019
pubmed:
31
5
2020
medline:
28
4
2021
entrez:
31
5
2020
Statut:
ppublish
Résumé
Anatomical resection (AR) is a recommended surgical treatment for hepatocellular carcinoma (HCC), although the conventional procedure (dye injection) for AR is difficult to reproduce.1,2 The tumor-feeding portal pedicle compression technique has been proposed as an easy, reversible, repeatable, and oncologically suitable procedure,3-5 and its only drawback is the sometimes faint discoloration of the compressed area. For enhancing its visibility, indocyanine green (ICG) fluorescence imaging has been introduced. This technique is herein disclosed while performing an anatomical S8 dorsal subsegmentectomy. A 66-year-old male was admitted for a 3.7 cm HCC in segment 8 dorsal (S8d) grown in non-alcoholic steatohepatitis. The preoperative liver function was graded as Child-Pugh class A. After adequate liver mobilization, the subsegmental Glissonian pedicle to S8d was identified by intraoperative ultrasound (IOUS) and compressed transparenchymally between the probe and the surgeon's fingertip positioned at the opposed side of the liver. Once IOUS-guided vessel compression had begun, ICG was administered intravenously. The compressed vessel created a non-stained area, which was marked using electrocautery. An anatomical S8d subsegmentectomy using the ICG compression technique was performed. There was no congested area and the right hepatic vein was exposed at the hepatocaval confluence because the resection was conducted in a subsegmental fashion. There was no morbidity and no blood transfusions were necessary. The patient was discharged on day 6 after surgery. This video shows, for the first time, the finger compression technique successfully implemented by ICG imaging for performing an AR for HCC.
Sections du résumé
BACKGROUND
BACKGROUND
Anatomical resection (AR) is a recommended surgical treatment for hepatocellular carcinoma (HCC), although the conventional procedure (dye injection) for AR is difficult to reproduce.1,2 The tumor-feeding portal pedicle compression technique has been proposed as an easy, reversible, repeatable, and oncologically suitable procedure,3-5 and its only drawback is the sometimes faint discoloration of the compressed area. For enhancing its visibility, indocyanine green (ICG) fluorescence imaging has been introduced. This technique is herein disclosed while performing an anatomical S8 dorsal subsegmentectomy.
METHODS
METHODS
A 66-year-old male was admitted for a 3.7 cm HCC in segment 8 dorsal (S8d) grown in non-alcoholic steatohepatitis. The preoperative liver function was graded as Child-Pugh class A. After adequate liver mobilization, the subsegmental Glissonian pedicle to S8d was identified by intraoperative ultrasound (IOUS) and compressed transparenchymally between the probe and the surgeon's fingertip positioned at the opposed side of the liver. Once IOUS-guided vessel compression had begun, ICG was administered intravenously. The compressed vessel created a non-stained area, which was marked using electrocautery.
RESULTS
RESULTS
An anatomical S8d subsegmentectomy using the ICG compression technique was performed. There was no congested area and the right hepatic vein was exposed at the hepatocaval confluence because the resection was conducted in a subsegmental fashion. There was no morbidity and no blood transfusions were necessary. The patient was discharged on day 6 after surgery.
CONCLUSIONS
CONCLUSIONS
This video shows, for the first time, the finger compression technique successfully implemented by ICG imaging for performing an AR for HCC.
Identifiants
pubmed: 32472410
doi: 10.1245/s10434-020-08644-x
pii: 10.1245/s10434-020-08644-x
doi:
Substances chimiques
Indocyanine Green
IX6J1063HV
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5197Références
Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet. 1985;161:346–350.
pubmed: 2996162
Takayama T, Makuuchi M, Watanabe K, et al. A new method for mapping hepatic subsegment: counterstaining identification technique. Surgery. 1991;109:226–229.
pubmed: 1846986
Torzilli G, Procopio F, Cimino M, et al. Anatomical segmental and subsegmental resection of the liver for hepatocellular carcinoma: a new approach by means of ultrasound-guided vessel compression. Ann Surg. 2010;251:229-35.
doi: 10.1097/SLA.0b013e3181b7fdcd
Torzilli G, Cimino M, Del Fabbro D, et al. Anatomical resection of segment 8 by means of ultrasound-guided vessel compression. Ann Surg Oncol. 2013;20:474.
doi: 10.1245/s10434-012-2695-6
Viganò L, Procopio F, Mimmo A, et al. Oncologic superiority of anatomic resection of hepatocellular carcinoma by ultrasound-guided compression of the portal tributaries compared with nonanatomic resection: an analysis of patients matched for tumor characteristics and liver function. Surgery. 2018;164:1006-1013.
doi: 10.1016/j.surg.2018.06.030