Application of Laennec extrathecal blockade combined with indocyanine green fluorescence imaging in laparoscopic anatomic hepatectomy

Objective To investigate the safety and application value of combining Laennec extracapsular occlusion with ICG fluorescence imaging in laparoscopic anatomic hepatectomy. Methods Complete laparoscopic dissection was performed outside the Laennec sheath, blocking Glisson's pedicle of the corresp...

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Bibliographic Details
Published in:ANZ journal of surgery 2024-04, Vol.94 (4), p.655-659
Main Authors: Yang, Yong, Yu, Chong‐yuan, Lin, Fang, Sun, Dong‐lin, Wu, Ke‐jia, Cai, Hui‐hua, Shi, Long‐qing, Zhu, Qiang
Format: Article
Language:English
Subjects:
Bile
Bile ducts
Blocking
Cancer
Complications
Dyes
Fluorescence
Hemangioma
Hepatectomy
Hepatectomy - methods
Humans
ICG
Imaging techniques
Indocyanine Green
Laennec membrane/capsule
laparoscope
Laparoscopy
Laparoscopy - methods
Liver cancer
Liver Neoplasms - diagnostic imaging
Liver Neoplasms - pathology
Liver Neoplasms - surgery
Locating
Medical imaging
Metastases
Occlusion
Optical Imaging - methods
Postoperative
Safety
Segments
sheath outside block
Sheaths
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Summary:Objective To investigate the safety and application value of combining Laennec extracapsular occlusion with ICG fluorescence imaging in laparoscopic anatomic hepatectomy. Methods Complete laparoscopic dissection was performed outside the Laennec sheath, blocking Glisson's pedicle of the corresponding liver segment or lobe. An appropriate amount of indocyanine green (ICG) dye was intravenously injected, and the boundary line between the pre‐cut liver segment and liver lobe was identified using fluorescence laparoscopy. Complete resection of the liver segment or lobe was performed based on anatomical markers. Clinical data, including operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications, were collected. Results A total of 14 cases were included in the study, including seven cases of primary liver cancer, three cases of metastatic liver cancer, three cases of intrahepatic bile duct calculi, and one case of hepatic hemangioma. All 14 patients underwent anatomic hepatectomy under fluorescent laparoscopy, with four cases involving the right liver, seven cases involving the left liver, two cases involving the right anterior lobe, and one case involving the right posterior lobe. Conclusion Combining laparoscopic follow‐up of the Laennec membrane with Glisson outer sheath block and intraoperative ICG fluorescence imaging provides real‐time guidance for locating the resection boundaries during anatomic hepatectomy. This approach helps in controlling intraoperative bleeding, reducing operation time, and ensuring high safety. It holds significant value in clinical application. Figure A, B: The dissected liver pedicle was separated along the Laennec membrane, and the target liver pedicle was clamped to block the blood flow into the liver from the pre‐cut liver leaf; C: Peripheral intravenous ICG was injected, and the boundary line of the pre‐resection liver was found under fluorescence laparoscopy.D: The target liver was completely resected along the section of the pre‐cut liver under real‐time fluorescence laparoscopic localization. (A case study of laparoscopic anatomic resection of right posterior lobe of liver).
ISSN:1445-1433
1445-2197
DOI:10.1111/ans.18907