Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
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 by The 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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
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.

Keywords: Laparoscopic left hemihepatectomy; Indocyanine green; Cranial-dorsal approach; Laparoscopic hepatectomy; Arantius ligament; Glissonean pedicle

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.