ISSN: 1859 - 2872
Clinical, paraclinical, and intraoperative characteristics of anatomical laparoscopic liver resection using indocyanine green fluorescence for hepatocellular carcinoma
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Abstract
Objective: To describe the preoperative clinical and paraclinical characteristics and to evaluate intraoperative outcomes of laparoscopic anatomical liver resection for hepatocellular carcinoma using Indocyanine Green (ICG) fluorescence guidance. Subject and method: This was a prospective, single-arm interventional study conducted on 50 patients with hepatocellular carcinoma who underwent laparoscopic anatomical liver resection with ICG fluorescence guidance at 108 Military Central Hospital from December 2024 to December 2025. Variables analyzed included preoperative clinical, paraclinical, and imaging characteristics, as well as intraoperative parameters. Results: The mean age was 59.2 ± 10.0 years, with males accounting for 88.0%. The prevalence of hepatitis B and hepatitis C infection was 70.0% and 8.0%, respectively. All patients were classified as Child-Pugh class A. On CT imaging, 88.0% of patients had cirrhosis, and 88.0% presented with a solitary tumor. The mean maximum tumor size was 43.1 ± 23.2 mm. The mean serum AFP level was 224.91 ± 463.41 ng/mL, and the mean PIVKA-II level was 1748.39 ± 6029.74 mAU/mL. Intraoperatively, cirrhotic liver parenchyma was observed in 68.0% of patients, and 76.0% of tumors were located superficially. ICG fluorescence provided clear visualization in 100% of cases, with no recorded adverse reactions. The mean operative time was 137.0 ± 52.2 minutes, and the mean estimated blood loss was 173.0 ± 149.3 mL. One patient (2.0%) required intraoperative blood transfusion. No cases required conversion to open surgery, and no anatomical complications were reported. Conclusion: Laparoscopic anatomical liver resection using ICG fluorescence guidance for hepatocellular carcinoma is a feasible and safe approach. This technique provides effective intraoperative navigation, with a high fluorescence detection rate, low blood loss, low transfusion rate, and no observed conversion to open surgery or anatomical complications in this series.
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References
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