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Background <p>For tumors located in the central and partially left lateral lobe of the liver without left Glisson pedicle invasion, anatomical central combined with (sub) segment of left lobe hepatectomy is an alternative to extended left hepatectomy (EH), achieving radical resection while preserving more liver parenchyma.<sup><CitationRef CitationID="CR1">1</CitationRef>,<CitationRef CitationID="CR2">2</CitationRef></sup> However, this procedure is technically challenging, especially under laparoscopy, which has not been reported.<sup><CitationRef CitationID="CR3">3</CitationRef>,<CitationRef CitationID="CR4">4</CitationRef></sup></p> Patient and Methods <p>A 40&#xa0;year-old male presented with hepatic tumor and liver cirrhosis. A three-dimensional model confirmed a tumor in the central lobe (S4/S5/S8) with partial invasion of the ventral subsegment of segment 3(S3v) (Fig. <InternalRef RefID="Fig1">1</InternalRef>A). Therefore, anatomical resection of S4/S5/S8 and S3v was performed, instead of EH in which the remaining liver volume was only 28.2%. Intraoperatively, the umbilical fissure approach was adopted to sequentially transect Glisson pedicles of S4 and S3v (Fig. <InternalRef RefID="Fig1">1</InternalRef>B). Then, the ischemic line was demarcated to guide the left resection margin, consistent with preoperative planning (Fig. <InternalRef RefID="Fig1">1</InternalRef>C). After blocking the right anterior Glisson pedicle, the boundary between right anterior and posterior sectors was clearly delineated (Fig. <InternalRef RefID="Fig1">1</InternalRef>D), using indocyanine green (ICG) negative staining. Parenchyma transection was performed under fluorescence tracing. Finally, the tumor was completely resected, with full exposure of the right hepatic vein trunk.</p> Results <p>The operation lasted 270&#xa0;min with 50&#xa0;mL of intraoperative blood loss. Histopathology confirmed moderate-to-poorly differentiated hepatocellular carcinoma with negative resection margins. The patient was discharged on postoperative day 8 without any complications.</p> Conclusions <p>Laparoscopic anatomical central combined with (sub) segment of left lobe hepatectomy guided by umbilical fissure approach and ICG fluorescence imaging is feasible for complex centrally located hepatocellular carcinoma.</p>

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Laparoscopic Anatomical S4/5/8+S3v Hepatectomy: Umbilical Fissure Approach Combined with Indocyanine Green Fluorescence Imaging

  • 期刊论文

  • 发表日期：

    2026年2月13日

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  • Pengbo Wu,
  • Nadila Erxiding,
  • Jian Yang

摘要

Background

For tumors located in the central and partially left lateral lobe of the liver without left Glisson pedicle invasion, anatomical central combined with (sub) segment of left lobe hepatectomy is an alternative to extended left hepatectomy (EH), achieving radical resection while preserving more liver parenchyma.1,2 However, this procedure is technically challenging, especially under laparoscopy, which has not been reported.3,4

Patient and Methods

A 40 year-old male presented with hepatic tumor and liver cirrhosis. A three-dimensional model confirmed a tumor in the central lobe (S4/S5/S8) with partial invasion of the ventral subsegment of segment 3(S3v) (Fig. 1A). Therefore, anatomical resection of S4/S5/S8 and S3v was performed, instead of EH in which the remaining liver volume was only 28.2%. Intraoperatively, the umbilical fissure approach was adopted to sequentially transect Glisson pedicles of S4 and S3v (Fig. 1B). Then, the ischemic line was demarcated to guide the left resection margin, consistent with preoperative planning (Fig. 1C). After blocking the right anterior Glisson pedicle, the boundary between right anterior and posterior sectors was clearly delineated (Fig. 1D), using indocyanine green (ICG) negative staining. Parenchyma transection was performed under fluorescence tracing. Finally, the tumor was completely resected, with full exposure of the right hepatic vein trunk.

Results

The operation lasted 270 min with 50 mL of intraoperative blood loss. Histopathology confirmed moderate-to-poorly differentiated hepatocellular carcinoma with negative resection margins. The patient was discharged on postoperative day 8 without any complications.

Conclusions

Laparoscopic anatomical central combined with (sub) segment of left lobe hepatectomy guided by umbilical fissure approach and ICG fluorescence imaging is feasible for complex centrally located hepatocellular carcinoma.