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This case presents a 75-year-old male with compensated cirrhosis, hypertension, type 2 diabetes, and nephropathy, undergoing laparoscopic resection of segment IVA and B for hepatocellular carcinoma (HCC). Preoperative imaging revealed a 49mm lesion in segment IVA, consistent with HCC, and chronic liver disease. Intraoperative indocyanine green (ICG) fluorescence was employed to guide resection and delineate anatomical landmarks in this cirrhotic patient.
The procedure involved a five-port technique, with the Pringle maneuver used to control intraoperative bleeding. Key steps included meticulous mobilization of the liver, identification of segment IV pedicles, and parenchymal transection with ICG guidance, ensuring clear resection margins. The use of ultrasound and ICG allowed precise localization of biliary and vascular structures, critical in cirrhotic patients where anatomical variations may be present.
The surgery was successfully completed with a total Pringle maneuver time of 100 minutes. The postoperative pathology confirmed a 50mm HCC without vascular invasion. The patient was discharged on the third postoperative day without complications, and no recurrence was noted after 20 months of follow-up.