ICG fluorescence-navigation laparoscopic right anterior hepatic lobectomy (counterstaining): A video article

This case report describes a patient with chronic hepatitis B virus infection and cirrhosis complicated by primary liver cancer. Preoperative assessments utilizing MRI and contrast-enhanced ultrasonography were conducted to ascertain the relationship between the tumour and surrounding vascular structures, leading to the formulation of a surgical plan for laparoscopic right anterior hepatic lobectomy with fluorescence guidance. This approach avoids complete right hepatic lobectomy and minimizes the risk of postoperative liver failure due to insufficient liver volume. The surgical video demonstrates the method of prioritizing Glisson sheath external blockade of the right anterior hepatic pedicle, administering indocyanine green (ICG) via peripheral venous injection, and accurately delineating the margin of the right anterior lobe on the basis of real-time ischaemic line assessments and fluorescence counterstaining. Combining intraoperative ultrasound and hepatic pedicle blood flow occlusion techniques enabled precise resection of the right anterior lobe. The operation lasted 370 min, with an intraoperative blood loss of 200 ml, and the postoperative recovery was smooth. The application of indocyanine green fluorescence imaging technology markedly enhances the determination and correction of anatomical boundaries for liver resection, combined with the Glisson extra-sheath transverse approach, thereby facilitating more precise anatomical, functional, and curative surgical outcomes.