To evaluate the safety and efficacy of extrathecal transection of Glisson's pedicle via Laennec's capsule combined with ICG fluorescence imaging in anatomic hepatectomy.

Clinical data of 25 patients undergoing hepatectomy in the First Affiliated Hospital of Jishou University from January 2022 to October 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 11 patients were male and14 female, aged from 45 to 73 years, with a median age of 50 years. Intraoperatively, Glisson's pedicle was dissected via the space of Laennec's capsule, and the transection of target Glisson's pedicle was achieved by suspension of elastic band. Anatomic hepatectomy was performed by peripheral intravenous injection of ICG using ICG fluorescence imaging. The safety and efficacy of this procedure were observed.

All patients successfully completed the surgery without perioperative death. Anatomic hepatectomy was performed by extrathecal transection of Glisson's pedicle via Laennec's capsule combined with ICG fluorescence imaging. Among them, 4 patients underwent the left lateral lobe resection, 1 case of the left inferior lobe resection, 7 cases of left liver resection, 2 cases of the right anterior lobe resection, 2 cases of the right posterior lobe resection, 3 cases of the right liver resection, 1 case of S2 segment resection, 2 cases of S3 segment resection, 1 case of S3 + S4 segment resection, 1 case of S4 + right anterior ventral segment resection, and 1 case ofS6 + S5d segment resection, respectively. The tissue function of the remaining liver volume was preserved to the largest extent when the diseased liver was resected, and no iatrogenic bile duct vascular injury was reported. The median operation time was 4.3(1.5-6.0) h. Intraoperative blood loss was 80(20-600) ml. The liver function was restored to normal within postoperative 1 week, and no postoperative bleeding or bile leakage occurred.

Extrathecal transection of Glisson's pedicle via Laennec's capsule combined with ICG fluorescence imaging in anatomic hepatectomy is a safe and effective procedure in anatomic hepatectomy, which provides novel ideas for establishing a streamlined and standardized anatomic hepatectomy.