How to Perform Laparoscopic Right Posterior Sectionectomy when the Right Intersectional Plane is not Always Flat
摘要
The right hepatic vein (RHV) is a crucial anatomical landmark, usually fully exposed during laparoscopic right posterior sectionectomy (LRPS).
A 51-year-old male was diagnosed with hepatocellular carcinoma in the right posterior section. Three-dimensional (3D) analysis indicated that Segment 6 extended over the ventral side of the RHV, and Segment 8 extended over the dorsal side of the RHV, which leads to the right intersectional plane being irregular and curved. Following the blockage of the right posterior Glissonean pedicle (RPGP) guided by ARN, ICG negative staining was performed. The fluorescent boundaries demonstrated concordance with the preoperative 3D model. The intrahepatic transection plane was guided by fluorescence imaging navigation combined with the identification of hepatic veins through ARN.
ResultsThe total operative time was 415 min with blood loss of 100 ml. The patient did not experience complications.
ConclusionsThe utilization of ICG fluorescence imaging combined with ARN for LRPS in cases with irregular right intersectional planes has proven safe and feasible.