Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2021; 13(3): 323-329
Published online Mar 27, 2021. doi: 10.4240/wjgs.v13.i3.323
Functional anatomical hepatectomy guided by indocyanine green fluorescence imaging in patients with localized cholestasis: Report of four cases
Hong-Wei Han, Ning Shi, Yi-Ping Zou, Yuan-Peng Zhang, Ye Lin, Zi Yin, Zhi-Xiang Jian, Hao-Sheng Jin
Hong-Wei Han, Hao-Sheng Jin, The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Hong-Wei Han, Ning Shi, Yi-Ping Zou, Yuan-Peng Zhang, Ye Lin, Zi Yin, Zhi-Xiang Jian, Hao-Sheng Jin, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
Author contributions: Jin HS and Shi N were the patients’ surgeons and designed the research; Han HW and Shi N reviewed the literature and contributed to the drafting of the manuscript; Zou YP and Zhang YP collected the surgical data and video recordings; Han HW and Lin Y processed the operation screenshots; Yin Z was responsible for the language editing and revision of the manuscript; Jian ZX and Jin HS supervised the revision of the manuscript; all authors took part in the final approval for the version to be submitted.
Supported by National Natural Science Foundation of China, No. 81972792.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hao-Sheng Jin, MD, Surgeon, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan Er Road, Guangzhou 510080, Guangdong Province, China.
Received: November 4, 2020
Peer-review started: November 4, 2020
First decision: November 25, 2020
Revised: December 9, 2020
Accepted: January 14, 2021
Article in press: January 14, 2021
Published online: March 27, 2021

Liver cancer is a malignant tumor with a high incidence. At present, the most effective treatment is laparoscopic hepatectomy (LH). Indocyanine green fluorescence imaging (ICG-FI) has become an important tool in LH, and the most common fluorescent types of tumors are total fluorescence, partial fluorescence, and rim fluorescence.


We presented four cases of LH guided by ICG-FI in which we also observed the fourth special fluorescent type. When the tumor or intrahepatic stone compresses the adjacent bile duct to cause local cholestasis, the liver segment or subsegment with obstructed bile drainage will show strong fluorescence. Complete removal of the lesion together with the fluorescent liver parenchyma may help reduce the risk of tumor or stone recurrence.


This type of partial fluorescence can indicate local biliary compression, and the resection method is related to bile drainage, which may be called functional anatomical hepatectomy and ensures radical resection of the lesion.

Keywords: Indocyanine green, Localized cholestasis, Laparoscopic hepatectomy, Unique fluorescent phenomenon, Functional anatomical hepatectomy, Case report

Core Tip: During laparoscopic hepatectomy guided by indocyanine green fluorescence imaging, tumor fluorescence usually manifests as total fluorescence, partial fluorescence, or rim fluorescence. However, surgeons occasionally encounter liver segment or subsegment fluorescence due to the tumor compressing the bile duct and local cholestasis. Despite malignant infiltration, stone compression and tumor thrombi in the bile duct can also cause this rare phenomenon. Complete removal of the lesions together with the fluorescent liver segment may help reduce the risk of tumor relapse, which can be called functional anatomical hepatectomy.