Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France.
University of Rennes 1, Rennes, France.
Ann Surg Oncol. 2024 Jun;31(6):4030. doi: 10.1245/s10434-024-15151-w. Epub 2024 Mar 20.
Laparoscopic right anterior sectionectomy (LRAS) remains a technically demanding procedure as it requires two transection planes where the middle and right hepatic veins run; however, the main difficulty is locating these two planes. The aim of this video was to show the technique of an LRAS performed with a transparenchymal glissonean pedicle approach and guided by indocyanine green (ICG) staining.
This was the case of an 80-year-old man with a history of hemochromatosis and normal liver function. He was diagnosed with a 6 cm hepatocellular carcinoma (HCC) located at segment 8, close to the right anterior pedicle.
The technique consisted of parenchymal transection along the main portal fissure along the right border of the middle hepatic vein. Opening the liver facilitated access to the right anterior glissonean pedicle and selective transparenchymal clamping. A negative-stain ICG test permitted to demarcate the transection line along the right lateral portal fissure. The parenchymal transection was carried out in a caudal approach, along two perfectly marked planes, preserving the middle and right hepatic veins. The duration of the procedure was 200 min and blood loss was 300 mL. Postoperative course was uneventful and the patient was discharged on the third postoperative day.
Guidance during resection, and protection of the right posterior pedicle and right hepatic vein are the key points of the LRAS. The glissonean approach and the ICG imaging technology are of great help in resolving these difficulties.
腹腔镜右前叶切除术（LRAS）仍然是一项技术要求很高的手术，因为它需要在中间和右肝静脉走行的两个平面进行横断；然而，主要的困难是定位这两个平面。本视频旨在展示采用透明肝门入路和吲哚菁绿（ICG）染色引导下进行 LRAS 的技术。
这是一位 80 岁男性的病例，有血色素沉着症和正常肝功能病史。他被诊断为位于第 8 段的 6 厘米大肝细胞癌（HCC），靠近右前叶蒂。
技术包括沿中肝静脉右缘的主门静脉裂进行实质横断。打开肝脏便于进入右前叶门脉蒂和选择性透明肝门夹闭。阴性染色的 ICG 试验允许沿右外侧门静脉裂划定横断线。实质横断采用尾侧入路，沿两条完全标记的平面进行，保留中间和右肝静脉。手术过程持续 200 分钟，失血量 300 毫升。术后过程顺利，患者在术后第 3 天出院。
切除过程中的引导以及保护右后叶蒂和右肝静脉是 LRAS 的关键要点。肝门入路和 ICG 成像技术在解决这些困难方面有很大帮助。
