Portal vein-based subsegmental classification of liver segment four for parenchyma-sparing laparoscopic resection: A retrospective study

Figure 9 Portal-based subsegmental resection of segment 4 L and segment 4R guided by Glissonean anatomy and indocyanine green fluorescence demarcation. A and B: Axial contrast-enhanced computed tomography images demonstrating separate inflow from the Glissonean pedicles of segment 4 (G4; G4 L and G4R) pedicles to the left and right of segment 4 (S4; S4 L and S4F) subsegments of S4, respectively (orange arrows); C: Three-dimensional portal vein reconstruction confirming a bilateral trunk-type configuration supplying S4 L and S4R; D and E: Intraoperative views showing identification and isolation of the G4R pedicle using the Glissonean approach; F: Surface marking of the liver based on anatomical landmarks delineating the boundary between S4 L and S4R; G-I: Indocyanine green fluorescence negative staining revealing distinct perfusion territories of S4 L and S4R, enabling precise subsegmental resection with functional parenchymal preservation and negative margins (R0). See Video 2 for operative details. S4: Segment 4; G4: Glissonean pedicles of segment 4.