Background: Laparoscopic right anterior sectionectomy (LRAS) is an attractive surgical option for tumors in the right anterior section (RAS), which can remove tumor-bearing segments while sparing more normal liver tissue. However, the definition of the resection plane, the guidance during the resection, and the protection of the right posterior hepatic duct are still the key points of this procedure. Our center attempted to use augmented reality navigation system and indocyanine green fluorescence (ICG) imaging technology to solve these difficulties, and reported this in LRAS for the first time.
Methods: A 47-year-old female was admitted to our institution for a tumor in the RAS. Therefore, LRAS was performed. First, a virtual liver segment projection combined with the ischemic line caused by the occlusion of RAS blood flow was used to mark the RAS boundary, and it was confirmed using the ICG negative staining. Then, during the parenchymal transection, the precise resection plane was guided assisted by the ICG fluorescence imaging system. In addition, the right anterior Glissonean pedicle (RAGP) was divided using a linear stapler after confirming the spatial relationship of the bile duct using ICG fluorescence imaging.
Results: The operation lasted 360 min with 100 mL of intraoperative blood loss. There were no postoperative complications, and the patient was discharged after 8 days.
Conclusion: The augmented reality navigation system plus ICG imaging can make LRAS more precisely and safely.