Use of indocyanine green fluorescence in assisting pediatric laparoscopic resection of hepatocellular carcinoma

Abstract

Background/Objectives: Recent advances in surgical techniques have resulted in the use of minimally invasive technique for liver resection in many centres. However, the resection margin is often difficult to define intra‐operatively, even with the help of ultrasound. As indocyanine green (ICG) is preferentially uptaken by hepatocytes and retained much longer by liver tumor cells, its use maybe applicable in intra‐operative localisation of tumor and defining the resection plane. Design/Methods: We here report a 9‐year old girl with 4x3x5cm hepatocellular carcinoma at segment 6, admitted for laparoscopic resection of tumor. One day prior to surgery, 5mg of ICG was given intravenously for intra‐operative imaging. Results: At the operation, the tumor mass was clearly shown up by ICG fluorescence. Resection margin could thus be delineated. Laparoscopic segmentectomy was performed uneventfully. Total operative blood loss was 290mls. The child made an excellent recovery and was discharged on post‐operative day 7. Conclusions: Both the safety and accuracy of laparoscopic liver resection for HCC has been enhanced by the use of ICG.