Fluorescence-Guided Laparoscopic Regional Anatomical Subsegmental Liver Resection Combined with Cholecystectomy through the Laennec Approach.

Laparoscopic hepatectomy is widely used for treating liver diseases, but achieving precise tumor resection with negative margins while preserving healthy liver parenchyma remains challenging. The Laennec's capsule approach has recently gained widespread use in liver surgery. This membrane facilitates perihepatic dissection, hepatic pedicle isolation, exposure of the hepatic veins, and anatomical hepatectomy. To address these difficulties, a technique combining Laennec's capsule dissection with indocyanine green (ICG) fluorescence guidance has been introduced. In this approach, the gallbladder is first removed via the Laennec capsule, after which the first and second branches of the segment 6 pedicle and the segment 5 pedicle are exposed and dissected. Hepatectomy is then performed under the guidance of fluorescence imaging and ischemic demarcation lines. The patient recovered uneventfully: the drainage tube was removed after five days, and he was successfully discharged on postoperative day five. Overall, the combination of ICG fluorescence and the Laennec approach offers a safe and effective strategy for precise hepatectomy.