Background : Prior to the advent of hepatectomy using ICG, in cases of major hepatectomies such as lobectomy or sectionectomy, when performing resection in the deep portion of the liver, hepatic vein-guided hepatectomy was typically conducted. This technique could lead to resecting liver parenchyma beyond the intended territory or creating an ischemic area. However, when performing hepatectomy using ICG, it allows for precise identification and resection of the territory dominated by target glisson even in the deep portion of the liver.

Methods : A 56-year-old man (BMI : 31.5 kg/m2) with chronic hepatitis B was referred for treatment of a single nodule in segment V. The preoperative alpha-fetoprotein (AFP) was 56.50 ng/ml. Liver function was Child-Pugh A. The surgical procedure involved the following steps: (1) Dissection of the extrahepatic Glisson pedicle was performed, utilizing Laennec's capsule, to isolate the right anterior glisson pedicle. (2) After ligating the target Glisson pedicle, ICG (1 ml, 5 mg/l) was intravenously administered to reveal the demarcation line through negative staining. (3) Transection of parenchyma was performed along the border of the negative staining area.

Results : The total operation time was 275 min, with an estimated blood loss of 100 mL. The final histopathological diagnosis showed a 3.9 × 2.8 × 2.1 cm-sized hepatocellular carcinoma. The patient was discharged on postoperative day (POD) 5 without any complications. On the CT scan performed on POD 5, the paracaval portion was observed without any signs of ischemia.

Conclusions : ICG makes true anatomical resection in hepatectomy.