Fluorescence-guided laparoscopic resection of liver segment 4 plus the right anterior ventral section for hepatocellular carcinoma adjacent to the left hepatic pedicle and middle hepatic vein: a case report

Hepatectomy is the mainstay of treatment for hepatocellular carcinoma (HCC). Indocyanine green (ICG) fluorescence-guided laparoscopic liver resection is a rapidly developing surgical approach for HCC that has several advantages, including more precise hepatectomy, reduced operative time, less blood loss, and fewer postoperative complications. In this case, a 71-year-old man with chronic hepatitis B and poor medication compliance was diagnosed with HCC. Imaging tests revealed a hepatic mass in segment 4 (S4), closely adjacent to the left hepatic pedicle (LP) and middle hepatic vein (MHV), and with severe liver cirrhosis. The patient underwent ICG fluorescence-guided laparoscopic resection of S4 plus the right anterior ventral section which was also defined as ventral section of segment 5 (S5v) plus segment 8 (S8v). The use of a three-dimensional (3D) reconstruction model improved our ability to develop an optimal surgical plan, and ICG-negative staining assisted in the successful execution of the procedure along the portal venous and hepatic venous territories. The patient, who had enough future liver remnant (FLR), successfully returned to normal life under the guidance of fast-track surgery, and there was no tumor recurrence in the 10-month follow-up period. Combining 3D reconstruction plus ICG fluorescence-guided laparoscopic hepatectomy can help achieve a successful resection of a tumor located in a difficult location for HCC patients presenting with liver cirrhosis. Our case provided clinicians with practical guidance for the management of similar cases, including the technical challenges and the educational value of combining 3D planning and ICG-guided fluorescence in a cirrhotic patient with a tumor located adjacent to major vessels.