First laparoscopic anatomical liver resection of segment 3 with Glissonean approach and negative fluorescent counterstaining in Georgia: A case report

Background: Laparoscopic liver resection (LLR) is a safely performed approach in referral centers. However, in many developing countries it is still not considered a routine procedure because of resourcefulness and lack of experience.

Newer techniques, like the Glissonean approach and use of Indocyanine Green (ICG), can be acquired thanks to training of liver surgeons in foreign referral tertiary centers. The purpose of the publication is to report the initial Georgian experience of LLR with Glissonean approach and intraoperative ICG.

Case presentation: A 37-year-old caucasian man with an 8-year history of chronic viral hepatitis B and subsequent liver cirrhosis, was operated on for a 6-cm HCC in segment 3. Laparoscopic segmentectomy was performed, by using extrafascial Glissonean approach for inflow control, and ICG for negative counterstaining. Operation duration was 150 min, estimated blood loss was about 60 ml. The patient was discharged from the hospital on a postoperative day 3 without notable complication.

Conclusion: A minimally invasive program comprehensive of anatomical LLR with Glissonean approach and intraoperative ICG can be carefully safely performed in Georgia, after appropriate training in referral centers.