Ultrasound-guided anatomical liver resection using a compression technique combined with indocyanine green fluorescence imaging

Background: Anatomical resection (AR) is a recommended surgical treatment for hepatocellular carcinoma (HCC). However, the conventional procedure (dye injection) for AR is difficult to reproduce. As an alternative, the tumour-feeding portal pedicle compression technique (finger-compression technique) has been proposed as an easy and reversible procedure. Here, we propose a new method combining indocyanine green (ICG) imaging with the finger-compression technique. Methods: Eligible patients were prospectively enrolled to undergo ICG compression (ICG-C) anatomical hepatectomy for HCC. Results: Fifteen patients underwent AR using the ICG-C technique. Overall, the surgical procedures included six segmentectomies, seven subsegmentectomies, and two right posterior sectionectomies. The median tumour size was 5.8 cm (range 2–7 cm). All procedures had an R0 margin. There were no major complications among patients, and minor morbidity occurred in three patients. Conclusions: ICG-C is a safe, feasible and effective technique for patients eligible for AR.