Identification of Liver Segments Guided by Indocyanine Green Fluorescence Imaging During Anatomical Liver Resections

  • Takeshi AokiEmail author
  • Doaa A. Mansour
  • Tomotake Koizumi
  • Masahiko Murakami


Anatomical liver resections (ALR) in the form of segmentectomy or subsegmentectomy require the clear demarcation of the segment volume of parenchyma to be resected. Indocyanine green (ICG) fluorescence achieved through either the positive or the negative staining technique combined with near-infrared (NIR) imaging technology constitutes a real-time intraoperative navigation tool during segmentectomy. The laparoscopic approach in ALR is continuously expanding rendering accurate segment demarcation even more crucial. Yet, ICG fluorescence imaging in laparoscopic ALR is associated with some specific challenges.

In the positive staining technique, ICG is directly injected into the segmental portal vein with the guidance of ultrasonography just before or during surgery. For negative ICG staining, segmental Glissonian pedicles are identified and temporarily occluded with the administration of ICG intravenously during surgery.

The target segment is visualized clearly on the liver surface by either its fluorescence (positive staining) or its distinct absence of fluorescence (negative staining). Its parenchymal boundaries are outlined by the plane between fluorescent and non-fluorescent liver tissue. Therefore, ICG fluorescence renders anatomical liver resections more feasible, accurate, and safe.


Near-infrared fluorescence imaging Indocyanine green Anatomical liver resection Subsegmentectomy Cone unit resection Laparoscopic hepatectomy 

Supplementary material

Video 13.1

Laparoscopic S2 subsegmentectomy with ICG fluorescence imaging (M4V 29104 kb)


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Takeshi Aoki
    • 1
    Email author
  • Doaa A. Mansour
    • 1
    • 2
  • Tomotake Koizumi
    • 1
  • Masahiko Murakami
    • 1
  1. 1.Division of Gastroenterological and General Surgery, Department of SurgeryShowa UniversityTokyoJapan
  2. 2.General Surgery DepartmentCairo University HospitalsCairoEgypt

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