Indocyanine green fluorescence-guided laparoscopic liver resection for hepatocellular carcinoma: a case report

Abstract

Indocyanine green (ICG) fluorescence imaging has emerged as a useful adjunct in laparoscopic liver surgery, providing real-time visualization of hepatocellular carcinoma (HCC) and assisting in tumor localization and determination of the parenchymal transection plane. Its role is particularly relevant in achieving adequate oncological clearance while preserving uninvolved liver parenchyma. A 60-year-old man with hepatitis B infection on treatment presented with abdominal pain and loss of appetite. Contrast-enhanced computed tomography demonstrated a solitary 5.1×5.8×5.7 cm segment 3 lesion with arterial-phase enhancement and venous-phase washout, consistent with HCC. Liver function was preserved, with no evidence of portal hypertension. ICG was administered intravenously at a dose of 0.5 mg/kg, 48 hours before surgery. During laparoscopy, near-infrared fluorescence imaging clearly identified the tumor and delineated its boundaries from the surrounding liver parenchyma. The fluorescence was used to guide parenchymal transection, and a laparoscopic left lateral sectionectomy was performed. Histopathological examination demonstrated a 6×5.5×4.8 cm well-differentiated HCC, with a tumor-free resection margin and pathological stage pT1b. ICG fluorescence imaging provides real-time intraoperative guidance during laparoscopic liver resection. In selected patients with HCC, its use may facilitate accurate tumor localization and margin-oriented parenchymal transection while preserving uninvolved liver parenchyma. Further prospective studies are required to establish whether routine use of ICG fluorescence translates into improved long-term oncological outcomes.