Reappraisal of a Dye-Staining Technique for Anatomic Hepatectomy by the Concomitant Use of Indocyanine Green Fluorescence Imaging》.pdf

SURGEON AT WORK Reappraisal of a Dye-Staining Technique for Anatomic Hepatectomy by the Concomitant Use of Indocyanine Green Fluorescence Imaging Akinori Miyata, MD, Takeaki Ishizawa, MD, PhD, FACS, Keigo Tani, MD, Atsushi Shimizu, MD, PhD, Junichi Kaneko, MD, PhD, Taku Aoki, MD, PhD, Yoshihiro Sakamoto, MD, PhD, Yasuhiko Sugawara, MD, PhD, Kiyoshi Hasegawa, MD, PhD, FACS, Norihiro Kokudo, MD, PhD, FACS Since anatomic (sub)segmentectomy of the liver was first identifying the boundaries of hepatic segments as ischemic reported by Makuuchi and colleagues1 in 1985, it has regions that appear on the liver surfaces after clamping the played an important role in the treatment of hepatic ma- corresponding Glissonian sheaths.5,6 More recently, Torz- lignancies by balancing curability and hepatic paren- zili and coworkers7,8 demonstrated that segmental bound- chymal preservation. Accurate transection of the liver aries could be identified as discolored regions simply by along its intersegmental planes obviates the need for por- compressing the hepatic parenchyma, thereby collapsing tal pedicles to be divided along the cutting line, which, in the corresponding portal pedicles, under IOUS guidance. turn, reduces operation time, amount of blood loss, and Even with these techniques, however, surgeons may the risk of postoperative bile leak. Especially in the treat- encounter difficulties in clearly identifying the boundaries ment of patients with hepatocellular carcinoma (HCC), of the hepatic segments based on naked-eye examinations anatomic segmentectomy has oncologic advantages in before hepatic transection, which, in turn, may decrease eradicating possi