Laparoscopic Anatomical Resection of the Dorsal Segment of the Right Anterior Section Using an Extrahepatic Glissonean Approach: 3D Reconstruction Simulation and ICG Fluorescent Navigation.

backgroundAdvances in laparoscopic techniques and technology have led to the increased performance of laparoscopic hepatectomy. Laparoscopic anatomical resection of the dorsal segment of the right anterior section (RAS) of the liver, however, remains complex and is infrequently performed because of its technical challenges. This study describes the laparoscopic anatomical resection of the dorsal segment of the RAS using an extrahepatic Glissonean approach, guided by preoperative 3D reconstruction and intraoperative indocyanine green (ICG) fluorescent imaging.

methodsA 3D reconstruction image was generated preoperatively for surgical planning, and the patient was placed in the lithotomy position with five trocars. The target dorsal Glissonean pedicle was isolated via an extrahepatic Glissonean approach. ICG fluorescent imaging provided real-time guidance, allowing for precise delineation of the dorsal segment. Parenchymal transection was completed under ICG guidance to maintain a clear intersegmental plane.

resultsThe operation time was 220 minutes, with an estimated blood loss of 80 mL and no blood transfusion required. Pathologic examination showed a 22-mm hepatocellular carcinoma with a 21-mm margin. No bile leakage was observed, and the patient was discharged on postoperative day 6 without complications.

conclusionsFindings in this patient demonstrate that the extrahepatic Glissonean approach, combined with 3D image reconstruction and ICG fluorescent imaging, enables precise, safe, and effective laparoscopic anatomical resection of the dorsal RAS segment. This approach has promise for the use of minimally invasive surgical techniques in advanced anatomical liver resection.