To explore the application value of three-dimensional (3D) visualization combined with intraoperative indocyanine green (ICG) fluorescence imaging in laparoscopic hepatectomy for primary liver cancer (PLC).

Clinical data of 51 patients with PLC who underwent laparoscopic hepatectomy using 3D visualization combined with intraoperative ICG fluorescence imaging in Zhongnan Hospital of Wuhan University from June 2017 to June 2018 were retrospectively analyzed. Among them, 24 patients were male and 27 female, aged (57±15) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. 3D reconstruction of the liver was performed by 3D visualization before operation to clarify the anatomy of hepatic vascular system and its relationship with the tumors. The resection line was determined with intraoperative ICG fluorescence imaging and color Doppler ultrasound and precise hepatectomy was performed subsequently. The operation time, intraoperative blood loss, incidence of complications and perioperative mortality were observed.

All 51 patients underwent laparoscopic hepatectomy successfully. No patient was transferred to open surgery. The operation time was (260±150) min, the intraoperative blood loss was (196±104) ml, and the postoperative length of hospital stay was (9±3) d. No postoperative liver failure or perioperative death occurred. Postoperative complications occurred in 5 cases, all of which were Clavien-Dindo grade II. All patients were cured and discharged after receiving conservative treatments. During the postoperative follow-up, recurrence or metastasis of liver cancer occurred in 4 patients.

3D visualization combined with ICG fluorescence imaging can display the relationship between the liver cancer and hepatic vascular structure clearly, and accurately predict the range of liver resection and improve the safety of laparoscopic hepatectomy.