ASO Author Reflections: Anatomical Liver Resection for Hepatocellular Carcinoma Using an Ultrasound-Guided Compression Technique Combined with Indocyanine Green Fluorescence Imaging

Excerpt

Hepatocellular carcinoma (HCC) has a high propensity to spread through the portal pedicles, therefore, anatomical resection (AR) is regarded as an effective treatment to avoid intrahepatic metastasis and recurrence. In 1985, Makuuchi et al.1 introduced the “dye injection” technique. This technique and its recent evolution in combination with indocyanine green (ICG) fluorescence2 require particular skill in intraoperative ultrasound (IOUS)-guided vessel puncturing, and in case of improper injection or dye reflux in other portal branches, may result in unreliable demarcation areas. Some alternative techniques have been proposed. One is the radiofrequency-assisted ablation of the tumour-bearing Glissonean pedicle (GP):3 its efficacy is negatively balanced by its irreversibility in the event of misinterpretation of the feeding GP to be ablated. A second technique is the hilar approach, which relies on a blunt encirclement of the GP from the hepatic hilum.4 Currently used also during laparoscopy, this remains technically demanding, introducing the potential risk of damaging the Glissonean pedicle and subsequently enlarging the liver portion to be resected. …