Abstract
Background
To date, most laparoscopic anatomic bi-segmentectomy practices have been performed vertically, such as the resection of segments 6 and 7, segments 5 and 8, and segments 2 and 3;1,2,3 however, transversal hepatectomy may be more appropriate for certain lesions that are located in a specific area.4,5 Herein, we present a video of a pure laparoscopic anatomic bi-segmentectomy (S5 and S6) using Takasaki’s approach and indocyanine green fluorescence navigation.
Method
A 58-year-old male with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) was admitted to our institution. The preoperative abdominal computed tomography (CT) scan showed a 5 × 4 cm tumor located between segments 5 and 6. Right hepatectomy was not adopted because of severe cirrhosis and portal hypertension. Therefore, laparoscopic anatomic bi-segmentectomy (5 and 6) was planned. After cholecystectomy, G5 and G6 were dissected and ligated using Takasaki’s Glissonean pedicle approach.6 The ischemic line then appeared on the liver surface. An intraoperative ultrasound was used to confirm that the tumor was within the ischemic line. Afterwards, intraoperative fluorescence navigation (negative stained) was performed to detect the demarcation line and guide the transection of liver parenchymal.
Results
The operative time was 225 min and the estimated blood loss was 150 mL. The total Pringle time was 75 min. The postoperative course was uneventful and the patient was discharged on postoperative day 8. Pathology confirmed the diagnosis of HCC and the surgical margin was negative.
Conclusions
Laparoscopic anatomic bi-segmentectomy (S5 and S6) is technically feasible and safe, which may be a beneficial alternative to formal right hepatectomy in some cases.
Similar content being viewed by others
References
Kim JH, et al. Tailored strategy for dissecting the Glissonean pedicle in laparoscopic right anterior sectionectomy: the extrahepatic, intrahepatic, and transfissural glissonean approaches (with video). Ann Surg Oncol. 2021;28(8):4238–44.
Willems E, et al. Comparison between minimally invasive right anterior and right posterior sectionectomy vs right hepatectomy: an international multicenter propensity score-matched and coarsened-exact-matched analysis of 1,100 patients. J Am Coll Surg. 2022;235(6):859–68.
McPhail MJ, et al. Laparoscopic versus open left lateral hepatectomy. Expert Rev Gastroenterol Hepatol. 2009;3(4):345–51.
Liu F, et al. Pure laparoscopic right upper transversal hepatectomy. Ann Surg Oncol. 2022;29(5):2977.
Zheng K, et al. Laparoscopic anatomic bi-segmentectomy (S3 and S4b) using the Glisson’s pedicle-first and intrahepatic anatomic markers approach. Surg Endosc. 2022;36(10):7859–60.
Takasaki K, et al. Highly anatomically systematized hepatic resection with Glissonean sheath code transection at the hepatic hilus. Int Surg. 1990;75(2):73–7.
Funding
This work was supported by a grant from the Sichuan Science and Technology Program (No. 2023YFQ0094).
Author information
Authors and Affiliations
Contributions
Conception of the work: FL. Collection of the data: WY. Clipped the video: WY. Wrote the paper: WY. Manuscript revision: FL, YW, and BL.
Corresponding author
Ethics declarations
Disclosure
Wugui Yang, Bo Li, Yonggang Wei, and Fei Liu have no competing financial interests to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Supplementary file1 (MP4 303428 kb)
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Yang, W., Li, B., Wei, Y. et al. Laparoscopic Anatomic Bi-segmentectomy (S5 and S6) Using Takasaki’s Approach and Indocyanine Green Fluorescence Navigation. Ann Surg Oncol 31, 3053–3054 (2024). https://doi.org/10.1245/s10434-024-14908-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-024-14908-7