Deng Haowen, Hu Haoyu, Huang Dongqing, Liang Yuan, Fang Chihua, Xiang Nan
Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
South China Institute of National Engineering Research Center of Innovation and Application of Minimally Invasive Instruments, Guangzhou, China.
Ann Surg Oncol. 2025 May;32(5):3499-3500. doi: 10.1245/s10434-025-16991-w. Epub 2025 Mar 4.
The right hepatic vein (RHV) is a crucial anatomical landmark, usually fully exposed during laparoscopic right posterior sectionectomy (LRPS). However, a discrepancy between the theoretical RHV-oriented plane and the actual right intersectional plane based on portal territory has been frequently observed in clinical practice. The potential reason for this discrepancy is branches of the Segment VI portal vein run on the ventral side of the RHV (Ventral-P6). The complexity of the procedure lies in the precise determination of the intrahepatic transection plane. Our center attempted to employ indocyanine green (ICG) fluorescence imaging combined with augmented reality navigation (ARN) to address the challenge.
A 51-year-old male was diagnosed with hepatocellular carcinoma in the right posterior section. Three-dimensional (3D) analysis indicated that Segment 6 extended over the ventral side of the RHV, and Segment 8 extended over the dorsal side of the RHV, which leads to the right intersectional plane being irregular and curved. Following the blockage of the right posterior Glissonean pedicle (RPGP) guided by ARN, ICG negative staining was performed. The fluorescent boundaries demonstrated concordance with the preoperative 3D model. The intrahepatic transection plane was guided by fluorescence imaging navigation combined with the identification of hepatic veins through ARN.
The total operative time was 415 min with blood loss of 100 ml. The patient did not experience complications.
The utilization of ICG fluorescence imaging combined with ARN for LRPS in cases with irregular right intersectional planes has proven safe and feasible.
右肝静脉（RHV）是一个关键的解剖标志，在腹腔镜右后叶切除术（LRPS）期间通常会完全暴露。然而，在临床实践中经常观察到基于门静脉区域的理论RHV导向平面与实际右交界面之间存在差异。这种差异的潜在原因是Ⅵ段门静脉分支走行于RHV腹侧（腹侧-P6）。该手术的复杂性在于肝内横断平面的精确确定。我们中心尝试采用吲哚菁绿（ICG）荧光成像联合增强现实导航（ARN）来应对这一挑战。
一名51岁男性被诊断为右后叶肝细胞癌。三维（3D）分析表明，6段延伸至RHV腹侧，8段延伸至RHV背侧，这导致右交界面不规则且呈弯曲状。在ARN引导下阻断右后Glissonean蒂（RPGP）后，进行ICG阴性染色。荧光边界与术前3D模型一致。肝内横断平面由荧光成像导航联合通过ARN识别肝静脉来引导。
总手术时间为415分钟，失血100毫升。患者未发生并发症。
对于右交界面不规则的病例，采用ICG荧光成像联合ARN进行LRPS已被证明是安全可行的。
