The application of the extraglissonian approach for selective hepatic inflow occlusion during laparoscopic anatomical segmentectomy

Objective:Laparoscopic anatomical hepatectomy has been proven to be achievable for segmentectomy,subsegmentectomy and multi-segmentectomy.The extraglissonian approach in the context of selective hepatic inflow ocdlusion has been skilled under laparoscopy.This study aims to examine the suitability of the technique stated above for laparoscopic anatomical hepatectomy.Methods:This retrospective study analyzed the dinical data of 114 patients diagnosed with hepatocel-lular carcinoma who underwent laparoscopic anatomical hepatectomy using the extraglissonian hepatic inflow occlusion technique at the Faculty of Hepato-Pancreato-Biliary Surgery,Chinese PLA General Hospital between September 2020 and December 2022.Results:The success rate of achieving the ischemic area using the described methods was determined to be 74.6%.Out of the 85 cases that underwent laparoscopic anatomical hepatectomy,34 cases involved segmentectomy,5 cases involved subsegmentectomy,and 46 cases involved multi-segmentectomy.The average duration of the operation,blood loss volume,and postoperative hospi-tal stay were 229.0±85.0 min,133.0±112.0 mL,and 5.4±1.7 d,res pectively.Notably,no intraoperative blood transfusions were necessary,and no postoperative complications were observed.Conclusion:The extraglissonian hepatic inflow occlusion technique exhibits a notable advantage in terms of a high success rate,effectively guiding the selection process during laparoscopic parenchymal tran-section.Moreover,this technique has demonstrated safety,reproducibility,and significant potential for broader clinical adoption.

3D laparoscopic anatomical hepatectomy guided by 2D real-time indocyanine green fluorescence imaging for hepatocellular carcinoma

Laparoscopic anatomical hepatectomy(LAH)for patients with hepatocellular carcinoma(HCC)has been advocated by many surgeons in the hope of producing better oncological outcomes.Two recent techniques,3D laparoscopic system and 2D real-time indocyanine green fluorescence imaging(r-ICG)guidance,are benefit for improving the operative precision of LAH in different aspects.However,these two techniques cannot be applied concomitantly because of the technical limitation.Although a new modern laparoscopic system with both 3D and indocyanine green(ICG)imaging mode has been designed,it has not been listed in many countries including China.Thus,we design a new procedure to perform the 3D LAH with 2D r-ICG guidance for HCCs with conventional laparoscopic systems.In this procedure,both 3D and 2D laparoscopic systems were used.A total of 11 patients with HCC received 3D laparoscopic right posterior sectionectomy(LRPS)with 2D r-ICG guidance.The right posterior Glissonian pedicle was clamped under the 3D vision.Then ICG solution was then intravenously administrated.The liver parenchyma was transected under the 3D vision and guided by 2D ICG vision simultaneously.There was no severe complications(Clavien-Dindo≥III)and operation related death.The 90-day mortality was also nil.By using this procedure,the advantages of two techniques,3D laparoscopic system and 2D r-ICG guidance,were combined so that LAH could be performed with more precision.However,it should be validated in more studies.