Indocyanine green (ICG) fluorescence evaluation of the middle hepatic vein (MHV) tributaries

Published: 06/14/2017

Indocyanine green (ICG) fluorescence evaluation of the middle hepatic vein (MHV) tributaries during extended right liver resection. After clamping the root of the MHV, and ligating the right portal vein and right hepatic artery, ICG (2·5 µg per ml of total liver) was injected intravenously. The liver surface was observed for 300 s. The fluorescence intensity (FI) on the liver surface increased gradually and then provided a clear demarcation of veno-occlusive regions corresponding to clamped MHV tributaries, non-veno-occlusive regions corresponding to left hepatic vein tributaries, and ischaemic regions corresponding to ligated right portal vein territories. The MHV was ligated and divided to preserve the MHV branches that drain segment IVa. After extended right liver resection and a second ICG injection, fluorescence imaging demonstrated that the FI of segment IVa reached a level similar to that of the left lateral section, implying absence of venous occlusion in segment IVa. Fluorescence imaging visualized veno-occlusive regions corresponding to the MHV tributaries that drain segment IVb, whereas they were unidentifiable by gross appearance. From: Liver transection using indocyanine green fluorescence imaging and hepatic vein clamping (Br J Surg 2017; 104: 898–906, http://onlinelibrary.wiley.com/doi/10.1002/bjs.10499/abstract)