To evaluate the safety and feasibility of A-P-R triangle dissection combined with ICG fluorescence staining in laparoscopic anatomical S5 segmentectomy.

Clinical data of 7 patients with primary liver cancer undergoing laparoscopic anatomical S5 segmentectomy in Cancer Hospital of Peking Union Medical College, Chinese Academy of Medical Sciences and Shengli Oilfield Central Hospital from December 1, 2020 to May 30, 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them,5 patients were male and 2 female, aged from 54 to 72 years, with a median age of 65 years. Intraoperatively, A-P-R triangle dissection combined with ICG fluorescence staining were adopted to display the boundary of liver segments, and laparoscopic anatomical S5 segmentectomy was performed. Intraoperative and postoperative conditions of all patients were observed.

All the patients underwent the surgery successfully without conversion to open surgery. Among them, 3 cases underwent S5 segmentectomy alone, 1 case underwent S5 segmentectomy combined with partial S4b segmentectomy and 3 cases ofS5 segmentectomy combined with partial S6 segmentectomy, respectively. The median operation time was 211(162-265) min, the hepatic portal occlusion time was 32(15-75) min, and intraoperative blood loss was 150(50-300) ml. No blood transfusion was delivered. The length of postoperative hospital stay was7(3-14) d. No severe complications, such as abdominal hemorrhage and liver failure, occurred after surgery. Postoperative bile leakage occurred in 1 case, who received drainage and extubation at postoperative 20 d. All patients were followed up till the day of manuscript submission. No tumor recurrence, metastasis or death was reported.

It is safe and feasible to perform A-P-R triangle dissection combined with ICG fluorescence staining in laparoscopic anatomical S5 segmentectomy.