Combination of a Glissonean Approach and Indocyanine Green Fluorescence Imaging to Perform a Laparoscopic Right Anterior Sectionectomy.
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:
20 Mar 2024
20 Mar 2024
Historique:
received:
18
09
2023
accepted:
20
02
2024
medline:
20
3
2024
pubmed:
20
3
2024
entrez:
20
3
2024
Statut:
aheadofprint
Résumé
Laparoscopic right anterior sectionectomy (LRAS) remains a technically demanding procedure as it requires two transection planes where the middle and right hepatic veins run; however, the main difficulty is locating these two planes This was the case of an 80-year-old man with a history of hemochromatosis and normal liver function. He was diagnosed with a 6 cm hepatocellular carcinoma (HCC) located at segment 8, close to the right anterior pedicle. The technique consisted of parenchymal transection along the main portal fissure along the right border of the middle hepatic vein. Opening the liver facilitated access to the right anterior glissonean pedicle and selective transparenchymal clamping. A negative-stain ICG test permitted to demarcate the transection line along the right lateral portal fissure. The parenchymal transection was carried out in a caudal approach, along two perfectly marked planes, preserving the middle and right hepatic veins. The duration of the procedure was 200 min and blood loss was 300 mL. Postoperative course was uneventful and the patient was discharged on the third postoperative day. Guidance during resection, and protection of the right posterior pedicle and right hepatic vein are the key points of the LRAS. The glissonean approach and the ICG imaging technology are of great help in resolving these difficulties.
Sections du résumé
BACKGROUND
BACKGROUND
Laparoscopic right anterior sectionectomy (LRAS) remains a technically demanding procedure as it requires two transection planes where the middle and right hepatic veins run; however, the main difficulty is locating these two planes
METHODS
METHODS
This was the case of an 80-year-old man with a history of hemochromatosis and normal liver function. He was diagnosed with a 6 cm hepatocellular carcinoma (HCC) located at segment 8, close to the right anterior pedicle.
RESULTS
RESULTS
The technique consisted of parenchymal transection along the main portal fissure along the right border of the middle hepatic vein. Opening the liver facilitated access to the right anterior glissonean pedicle and selective transparenchymal clamping. A negative-stain ICG test permitted to demarcate the transection line along the right lateral portal fissure. The parenchymal transection was carried out in a caudal approach, along two perfectly marked planes, preserving the middle and right hepatic veins. The duration of the procedure was 200 min and blood loss was 300 mL. Postoperative course was uneventful and the patient was discharged on the third postoperative day.
CONCLUSION
CONCLUSIONS
Guidance during resection, and protection of the right posterior pedicle and right hepatic vein are the key points of the LRAS. The glissonean approach and the ICG imaging technology are of great help in resolving these difficulties.
Identifiants
pubmed: 38506935
doi: 10.1245/s10434-024-15151-w
pii: 10.1245/s10434-024-15151-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. Society of Surgical Oncology.
Références
Kim KH, Kim HS, Lee YJ, Park KM, Hwang S, Ahn CS, et al. Clinical analysis of right anterior segmentectomy for hepatic malignancy. Hepatogastroenterology. 2006;53(72):836–9.
pubmed: 17153435
Kirchner VA, Kim KH, Kim SH, Lee SK. Pure laparoscopic right anterior sectionectomy for hepatocellular carcinoma with great vascular exposure. Surg Endosc. 2017;31(8):3349–50.
doi: 10.1007/s00464-016-5349-0
pubmed: 27928672
Chen HW, Wang FJ, Li JY, Deng FW, Lai ECH, Lau WY. Extra-glissonian approach for laparoscopic liver right anterior sectionectomy. JSLS. 2019;23(2):e2019.
doi: 10.4293/JSLS.2019.00009
pmcid: 6634953