Wang XR, Li XJ, Wan DD, Zhang Q, Liu TX, Shen ZW, Tong HX, Li Y, Li JW. Laparoscopic left hemihepatectomy guided by indocyanine green fluorescence: A cranial-dorsal approach. World J Gastrointest Surg 2024; 16(2): 409-418 [PMID: 38463374 DOI: 10.4240/wjgs.v16.i2.409]
Corresponding Author of This Article
Jian-Wei Li, PhD, Additional Professor, Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, No. 30 Gaotan Yanzheng Street, Shapingba District, Chongqing 400038, China. 594457357@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
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Wang XR, Li XJ, Wan DD, Zhang Q, Liu TX, Shen ZW, Tong HX, Li Y, Li JW. Laparoscopic left hemihepatectomy guided by indocyanine green fluorescence: A cranial-dorsal approach. World J Gastrointest Surg 2024; 16(2): 409-418 [PMID: 38463374 DOI: 10.4240/wjgs.v16.i2.409]
World J Gastrointest Surg. Feb 27, 2024; 16(2): 409-418 Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.409
Laparoscopic left hemihepatectomy guided by indocyanine green fluorescence: A cranial-dorsal approach
Xing-Ru Wang, Xiao-Ju Li, Dan-Dan Wan, Qian Zhang, Tian-Xi Liu, Zong-Wen Shen, Hong-Xing Tong, Yan Li, Jian-Wei Li
Xing-Ru Wang, Jian-Wei Li, Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, Chongqing 400038, China
Xiao-Ju Li, Qian Zhang, Tian-Xi Liu, Zong-Wen Shen, Hong-Xing Tong, Yan Li, Department of Hepatobiliary Surgery, Qujing Central Hospital of Yunnan Regional Medical Center, Qujing 655000, Yunnan Province, China
Dan-Dan Wan, School of Clinical Medicine, Qujing Medical College, Qujing 655000, Yunnan Province, China
Co-first authors: Xing-Ru Wang and Xiao-Ju Li.
Co-corresponding authors: Tian-Xi Liu and Jian-Wei Li.
Author contributions: Wang XR and Li XJ contributed equally to this work, reviewed and edited the manuscript; Wang XR and Li JW contributed to the conceptualization of the study; Wang XR contributed to the methodology, resources and funding acquisition, and is the project administration; Li XJ contributed to the software, formal analysis of the data, contributed to the data curation and drafted the manuscript; Wan DD contributed to the translation; Liu TX and Shen ZW contributed to the validation; Zhang Q contributed to the investigation; Shen ZW and Tong HX contributed to the visualization; Li JW supervised the study; all the authors have read and approved the final version.
Supported byThe High-level Talent Training Support Project of Yunnan Province, No. YNWR-MY-2020-053; and the Key Project of the Second People's Hospital of Qujing in 2022, No. 2022ynkt04.
Institutional review board statement: All methods were approved by the Research Medical Ethics Committee of Qujing Second People's Hospital and were performed in accordance with the approved guidelines (Ethical review: 2022-019-01).
Informed consent statement: All human tissue samples were collected by the Qujing Second People's Hospital and written informed consent was obtained from all patients.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: The data supporting this article will be shared upon reasonable request to the corresponding author.
Corresponding author: Jian-Wei Li, PhD, Additional Professor, Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, No. 30 Gaotan Yanzheng Street, Shapingba District, Chongqing 400038, China. 594457357@qq.com
Received: September 13, 2023 Peer-review started: September 13, 2023 First decision: December 8, 2023 Revised: December 14, 2023 Accepted: January 24, 2024 Article in press: January 24, 2024 Published online: February 27, 2024 Processing time: 165 Days and 3.8 Hours
Abstract
BACKGROUND
Advancements in laparoscopic technology and a deeper understanding of intrahepatic anatomy have led to the establishment of more precise laparoscopic hepatectomy (LH) techniques. The indocyanine green (ICG) fluorescence navigation technique has emerged as the most effective method for identifying hepatic regions, potentially overcoming the limitations of LH. While laparoscopic left hemihepatectomy (LLH) is a standardized procedure, there is a need for innovative strategies to enhance its outcomes.
AIM
To investigate a standardized cranial-dorsal strategy for LLH, focusing on important anatomical markers, surgical skills, and ICG staining methods.
METHODS
Thirty-seven patients who underwent ICG fluorescence-guided LLH at Qujing Second People's Hospital between January 2019 and February 2022 were retrospectively analyzed. The cranial-dorsal approach was performed which involves dissecting the left hepatic vein cephalad, isolating the Arantius ligament , exposing the middle hepatic vein, and dissecting the parenchyma from the dorsal to the foot in order to complete the anatomical LLH. The surgical methods, as well as intra- and post-surgical data, were recorded and analyzed. Our hospital’s Medical Ethics Committee approved this study (Ethical review: 2022-019-01).
RESULTS
Intraoperative blood loss during LLH was 335.68 ± 99.869 mL and the rates of transfusion and conversion to laparotomy were 13.5% and 0%, respectively. The overall incidence of complications throughout the follow-up (median of 18 months; range 1-36 months) was 21.6%. No mortality or severe complications (level IV) were reported.
CONCLUSION
LLH has the potential to become a novel, standardized approach that can effectively, safely, and simply expose the middle hepatic vein and meet the requirements of precision surgery.
Core Tip: Current laparoscopic hepatectomy (LH) approaches require advanced skills and pose challenges in anatomical landmark identification. Advancements in understanding intrahepatic anatomy and laparoscopic technology will improve LH procedures. By combining a cranial-dorsal approach along the middle vein with the use of indocyanine green staining, we introduce a novel method for laparoscopic left hemihepatectomy. Our new approach is feasible, streamlining the procedure for surgeons and assistants. Our preliminary results indicate that our approach might represent a significant improvement in LH outcomes. Enhanced LH approaches potentially improve patient outcomes.
