Abstract
Anatomical hepatectomy using indocyanine green (ICG) fluorescent imaging and the needle-guiding technique is described in this chapter. Using this procedure, the root of the portal vein of the segment including the hepatocellular carcinoma is punctured with a 22 G Cattelan needle under ultrasonography (US). After backflow is confirmed, 1 mL of diluted (twofold) ICG solution is injected into the branch of the portal vein and monitored by US. The surface of the liver is observed with the ICG fluorescent imaging system. This novel operative procedure using ICG fluorescent imaging is able to clearly visualize the margins between the liver segments. However, this method cannot be used to guide to the root of the relevant portal vein. In order to overcome this disadvantage, an indwelling needle (18 G/65 mm) is used to puncture the outside of the margin of the stained segments under US, and the tip of the outer needle is placed in close proximity of the portal vein. This needle-guiding technique can accurately be used to guide toward the root of the portal vein to be ligated. Moreover, counterstaining with ICG fluorescent imaging defines the avascular segment to be resected as the nonstaining area, and thus, the liver fed by the tumor-bearing portal vein can be successfully resected. Using the ICG fluorescent imaging and needle-guiding technique, anatomical hepatectomy can be performed correctly and safely.
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References
Bismuth H, Majno PE, Adam R (1999) Liver transplantation for hepatocellular carcinoma. Semin Liver Dis 19(3):311–322. doi:10.1055/s-2007-1007120
Fan ST, Cheung ST, Lo CM (2000) Indications for liver transplantation in patients with chronic hepatitis B and C virus infection and hepatocellular carcinoma. J Gastroenterol Hepatol 15(Suppl):E181–E186
Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology (Baltimore, MD) 30(6):1434–1440. doi:10.1002/hep.510300629
Margarit C, Escartin A, Castells L, Vargas V, Allende E, Bilbao I (2005) Resection for hepatocellular carcinoma is a good option in Child-Turcotte-Pugh class A patients with cirrhosis who are eligible for liver transplantation. Liver Transplant 11(10):1242–1251. doi:10.1002/lt.20398
Poon RT, Fan ST, Lo CM, Liu CL, Wong J (2002) Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg 235(3):373–382
Adachi E, Maeda T, Matsumata T, Shirabe K, Kinukawa N, Sugimachi K, Tsuneyoshi M (1995) Risk factors for intrahepatic recurrence in human small hepatocellular carcinoma. Gastroenterology 108(3):768–775
Adachi E, Maehara S, Tsujita E, Taguchi K, Aishima S, Rikimaru T, Yamashita Y, Tanaka S (2002) Clinicopathologic risk factors for recurrence after a curative hepatic resection for hepatocellular carcinoma. Surgery 131(1 Suppl):S148–S152
Ikai I, Arii S, Ichida T, Okita K, Omata M, Kojiro M, Takayasu K, Nakanuma Y, Makuuchi M, Matsuyama Y, Yamaoka Y (2005) Report of the 16th follow-up survey of primary liver cancer. Hepatol Res 32(3):163–172. doi:10.1016/j.hepres.2005.04.005
Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161(4):346–350
Eguchi S, Kanematsu T, Arii S, Okazaki M, Okita K, Omata M, Ikai I, Kudo M, Kojiro M, Makuuchi M, Monden M, Matsuyama Y, Nakanuma Y, Takayasu K (2008) Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery 143(4):469–475. doi:10.1016/j.surg.2007.12.003
Kamiyama T, Nakanishi K, Yokoo H, Kamachi H, Matsushita M, Todo S (2010) The impact of anatomical resection for hepatocellular carcinoma that meets the Milan criteria. J Surg Oncol 101(1):54–60. doi:10.1002/jso.21414
Kishi Y, Hasegawa K, Kaneko J, Aoki T, Beck Y, Sugawara Y, Makuuchi M, Kokudo N (2012) Resection of segment VIII for hepatocellular carcinoma. Br J Surg 99(8):1105–1112. doi:10.1002/bjs.8790
Yamamoto M, Katagiri S, Ariizumi S, Kotera Y, Takahashi Y, Egawa H (2014) Tips for anatomical hepatectomy for hepatocellular carcinoma by the Glissonean pedicle approach (with videos). J Hepato-biliary-Pancreat Sci 21(8):E53–E56. doi:10.1002/jhbp.117
Aoki T, Yasuda D, Shimizu Y, Odaira M, Niiya T, Kusano T, Mitamura K, Hayashi K, Murai N, Koizumi T, Kato H, Enami Y, Miwa M, Kusano M (2008) Image-guided liver mapping using fluorescence navigation system with indocyanine green for anatomical hepatic resection. World J Surg 32(8):1763–1767. doi:10.1007/s00268-008-9620-y
Kamiyama T, Nakagawa T, Nakanishi K, Kamachi H, Onodera Y, Matsushita M, Todo S (2006) Preoperative evaluation of hepatic vasculature by three-dimensional computed tomography in patients undergoing hepatectomy. World J Surg 30(3):400–409. doi:10.1007/s00268-005-0383-4
Takayama T, Makuuchi M, Watanabe K, Kosuge T, Takayasu K, Yamazaki S, Hasegawa H (1991) A new method for mapping hepatic subsegment: counterstaining identification technique. Surgery 109(2):226–229
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Kamiyama, T. et al. (2016). Anatomical Hepatectomy Using Indocyanine Green Fluorescent Imaging and Needle-Guiding Technique. In: Kusano, M., Kokudo, N., Toi, M., Kaibori, M. (eds) ICG Fluorescence Imaging and Navigation Surgery. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55528-5_27
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DOI: https://doi.org/10.1007/978-4-431-55528-5_27
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