Laparoscopic Anatomic Bi-segmentectomy (S5 and S6) Using Takasaki’s Approach and Indocyanine Green Fluorescence Navigation

To date, most laparoscopic anatomic bi-segmentectomy practices have been performed vertically, such as the resection of segments 6 and 7, segments 5 and 8, and segments 2 and 3;^1–3 however, transversal hepatectomy may be more appropriate for certain lesions that are located in a specific area.^4,5 Herein, we present a video of a pure laparoscopic anatomic bi-segmentectomy (S5 and S6) using Takasaki’s approach and indocyanine green fluorescence navigation.

A 58-year-old male with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) was admitted to our institution. The preoperative abdominal computed tomography (CT) scan showed a 5 × 4 cm tumor located between segments 5 and 6. Right hepatectomy was not adopted because of severe cirrhosis and portal hypertension. Therefore, laparoscopic anatomic bi-segmentectomy (5 and 6) was planned. After cholecystectomy, G5 and G6 were dissected and ligated using Takasaki’s Glissonean pedicle approach.⁶ The ischemic line then appeared on the liver surface. An intraoperative ultrasound was used to confirm that the tumor was within the ischemic line. Afterwards, intraoperative fluorescence navigation (negative stained) was performed to detect the demarcation line and guide the transection of liver parenchymal.

The operative time was 225 min and the estimated blood loss was 150 mL. The total Pringle time was 75 min. The postoperative course was uneventful and the patient was discharged on postoperative day 8. Pathology confirmed the diagnosis of HCC and the surgical margin was negative.

Laparoscopic anatomic bi-segmentectomy (S5 and S6) is technically feasible and safe, which may be a beneficial alternative to formal right hepatectomy in some cases.