We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Positive and Negative Staining of Hepatic Segments by Use of Fluorescent Imaging Techniques During Laparoscopic Hepatectomy

Takeaki Ishizawa, MD, PhD; Noah B. Zuker, MD; Norihiro Kokudo, MD, PhD; Brice Gayet, MD, PhD
Arch Surg. 2012;147(4):393-394. doi:10.1001/archsurg.2012.59.
Text Size: A A A
Published online


Anatomic hepatic segmentectomy1 plays an important role in the modern treatment of malignant disease. Segmentectomy maximizes postoperative hepatic functional reserve without compromising oncologic principles.2 This approach is particularly appropriate for a hepatocellular carcinoma segmental resection and may also be useful for other indications, such as a segmental resection for colorectal metastases and other hepatic tumors. The classic hepatic segment identification technique involves puncture of a segmental portal branch under the guidance of intraoperative ultrasonography. Vital blue dye is injected after temporarily clamping the hepatic artery to avoid dye washout from the segment.1 This staining technique is simple and useful for open surgery; however, it is much more difficult to reproduce these procedures laparoscopically and to confirm demarcation of the hepatic segment visually on the monitor. This problem may reduce the accuracy and frequency of anatomic segmentectomy using a laparoscopic blue dye approach.3 Recently, we have developed a laparoscopic fluorescent imaging system that allows visualization of indocyanine green (ICG) fluorescence to identify the biliary tract4 and liver cancers5 intraoperatively. Herein, we report our initial experience of applying this system to the visualization of hepatic segments during laparoscopic surgery, by injecting ICG dye into the segmental portal branch6 (positive staining) or by intravenously administering ICG dye after clamping the segmental portal pedicle (negative staining).

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Graphic Jump Location

Figure. Positive-staining (A) and negative-staining (B) techniques of hepatic segments using indocyanine green (ICG) fluorescent imaging during laparoscopic hepatectomy. A, Despite the thick connective tissue (due to a previous hepatectomy [right]) around the liver surface, fluorescent imaging (right) clearly delineates demarcation between segment IV (with fluorescence of ICG dye) and its surrounding nonfluorescent segments (video 1). B, Fluorescent imaging (right) clearly enables visualization of the demarcation between segment II (with portal uptake of ICG dye) and segment III (with ischemia after closure of the segmental portal branch). The normal color image shows minimal difference ([left]; video 2).




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

19 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections