The application value of extra-sheath dissection <i>via</i> the Laennec membrane space combined with indocyanine green fluorescence in laparoscopic anatomical hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHENG Peng ¹ , JIANG Kangyi ² , XIE Qingyun ³ , ZHAO Xin ⁴ , DU Bo ² , FU Jinqiang ² , MAO Tianyang ² , WANG Hongyuan ¹ , ZHOU Heng ¹ , LIU Zhuoran ² ,  GAO Fengwei ³

1. College of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
2. Department of Hepatobiliary & Pancreatic Surgery, The People’s Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;
3. Liver Transplant Center, Transplant Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
4. Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

GAO Fengwei, Email: gaofengwei@scu.edu.cn

Keywords：

Laennec capsule; fluorescence; extra-sheath dissection; laparoscopy; anatomical hepatectomy

DOI：

10.7507/1007-9424.202601131

Video：

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Objective To evaluate the safety and efficacy of extra-sheath dissection via the Laennec membrane space combined with indocyanine green (ICG) fluorescence navigation in laparoscopic anatomic hepatectomy. Methods A retrospective analysis was conducted on the clinical data of hepatocellular carcinoma patients who underwent laparoscopic anatomic hepatectomy at Leshan People’s Hospital between January 2022 and September 2025. The study group comprised patients who underwent the extra-sheath anatomical approach via the Laennec’s capsule space combined with ICG fluorescence navigation, while the control group consisted of patients who underwent the conventional intra-sheath Glissonean pedicle transection approach combined with intraoperative ultrasound. Results A total of 113 patients were included in this study, including 54 cases in the study group and 59 cases in the control group. Intraoperative blood loss [MD=–139.88 mL, 95%CI (–229.51, –50.25) mL], number of drainage tubes × drainage tube indwelling time [MD=–2.00 (tubes×d), 95%CI (–4.00, 0.00) (tubes×d)], postoperative ambulation time [MD=–0.58 d, 95%CI (–0.94, –0.22) d], alanine aminotransferase level on postoperative day 1 [MD=–129.83 U/L, 95%CI (–259.96, –5.71) U/L], aspartate aminotransferase level on postoperative day 1 [MD=–131.09 U/L, 95%CI (–259.12, –3.06) U/L], albumin level on postoperative day 1 [MD=1.64 g/L, 95%CI (0.21, 3.06) g/L], and hospitalization cost [MD=–5 523.10 yuan, 95%CI (–10 572.42, –471.77) yuan] of the study group were all better than those in the control group (P< 0.05). Conclusion Extra-sheath dissection via the Laennec membrane space combined with ICG fluorescence navigation can improve the safety and efficacy of laparoscopic anatomical hepatectomy, and is worthy to explore further its clinical application value.

Citation： ZHENG Peng, JIANG Kangyi, XIE Qingyun, ZHAO Xin, DU Bo, FU Jinqiang, MAO Tianyang, WANG Hongyuan, ZHOU Heng, LIU Zhuoran, GAO Fengwei. The application value of extra-sheath dissection via the Laennec membrane space combined with indocyanine green fluorescence in laparoscopic anatomical hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(3): 310-316. doi: 10.7507/1007-9424.202601131 Copy

1.	Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
2.	Kale SR, Karande G, Gudur A, et al. Recent trends in liver cancer: epidemiology, risk factors, and diagnostic techniques. Cureus, 2024, 16(10): e72239. doi: 10.7759/cureus.72239.
3.	Takayama T, Yamazaki S, Matsuyama Y, et al. Prognostic grade for resecting hepatocellular carcinoma: multicentre retrospective study. Br J Surg, 2021, 108(4): 412-418.
4.	Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet, 1985, 161(4): 346-350.
5.	鄭博文, 鄭樹國. 腹腔鏡解剖性肝切除術治療肝細胞癌的現狀與思考. 肝癌電子雜志, 2021, 8(4): 1-5.
6.	鄭樹國, 王星入, 李建偉. 腹腔鏡肝切除術中確定和顯露肝內重要解剖標志的意義和技術要點. 中國實用外科雜志, 2025, 45(8): 875-879.
7.	張文君, 陳曉鵬. Laennec膜及其在腹腔鏡肝膽外科手術中的應用. 肝膽胰外科雜志, 2024, 36(5): 257-261, 268.
8.	Hu Y, Shi J, Wang S, et al. Laennec’s approach for laparoscopic anatomic hepatectomy based on Laennec’s capsule. BMC Gastroenterol, 2019, 19(1): 194.
9.	Zeng H, Zheng R, Sun K, et al. Cancer survival statistics in China 2019-2021: a multicenter, population-based study. J Natl Cancer Cent, 2024, 4(3): 203-213.
10.	王安志, 張帆, 杜京洋, 等. 腹腔鏡門靜脈流域解剖性肝切除技術發展及要點. 中國普通外科雜志, 2025, 34(1): 62-69.
11.	Liu H, Hu FJ, Li H, et al. Anatomical vs nonanatomical liver resection for solitary hepatocellular carcinoma: a systematic review and meta-analysis. World J Gastrointest Oncol, 2021, 13(11): 1833-1846.
12.	任思謙, 陳晴, 原春輝. 肝臟的解剖學研究進展. 中華外科雜志, 2019, 57(7): 551-553.
13.	陳雷, 黃徐建, 陶計林, 等. 精準熒光導航: 吲哚菁綠在腹腔鏡解剖性肝切除術中的應用效果. 中國普外基礎與臨床雜志, 2025, 32(8): 978-983.
14.	Wang SD, Wang L, Xiao H, et al. Novel techniques of liver segmental and subsegmental pedicle anatomy from segment 1 to segment 8. World J Gastrointest Surg, 2024, 16(12): 3806-3817.
15.	楊陳鳳麟, 李堯, 王鑫, 等. “門理論”在微創解剖性肝切除術中的應用與展望. 中國實用外科雜志, 2024, 44(3): 341-345.
16.	Sugioka A, Kato Y, Tanahashi Y. Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec’s capsule: proposal of a novel comprehensive surgical anatomy of the liver. J Hepatobiliary Pancreat Sci, 2017, 24(1): 17-23.
17.	中國研究型醫院學會肝膽胰外科專業委員會, 《中華消化外科雜志》編輯委員會. 腹腔鏡解剖性肝切除手術操作流程及技術標準中國專家共識 (2023版). 中華消化外科雜志, 2023, 22(7): 810-823.
18.	王曉穎. 腹腔鏡解剖性肝切除術中熒光染色意外及對策. 中國實用外科雜志, 2022, 42(9): 1001-1004.
19.	季軍, 黃紀偉. 吲哚菁綠熒光染色技術在解剖性肝切除術中的應用現狀. 腹部外科, 2025, 38(1): 7-11.
20.	路志宇, 孫驥, 杜加錄, 等. 腹腔鏡解剖性半肝切除中肝蒂處理與吲哚菁綠劑量影響熒光染色效果的研究. 外科理論與實踐, 2024, 29(2): 138-142.
21.	王曉穎. 吲哚菁綠熒光成像技術在肝臟外科應用中國專家共識 (2023版). 中國實用外科雜志, 2023, 43(4): 371-383.
22.	劉杰, 成劍. 肝癌腹腔鏡解剖性肝切除術的若干問題再議. 肝膽胰外科雜志, 2020, 32(5): 265-269.
23.	Yang Y, Yu CY, Lin F, et al. Application of Laennec extrathecal blockade combined with indocyanine green fluorescence imaging in laparoscopic anatomic hepatectomy. ANZ J Surg, 2024, 94(4): 655-659.
24.	余德才. 肝臟膜性解剖及Laennec入路解剖性肝切除. 中華腔鏡外科雜志 (電子版), 2019, 12(6): 332-336.
25.	《中華消化外科雜志》編輯委員會, 中國研究型醫院學會肝膽胰外科專業委員會. 腹腔鏡門靜脈流域解剖性肝切除理論及技術標準中國專家共識 (2023版). 中華消化外科雜志, 2023, 22(12): 1385-1397.
26.	Hu M, Chen Z, Xu D, et al. Efficacy and safety of indocyanine green fluorescence navigation versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis. Surg Endosc, 2025, 39(3): 1681-1695.
27.	Li B, Yin D, Zhang Q, et al. Laennec approach for anatomical liver resection assisted by laparoscopy or robotics: a multicenter cohort study. Int J Surg, 2025, 111(2): 1929-1938.
28.	洪漢崟, 陳志堅, 池小斌, 等. 鞘外法和鞘內法Glisson蒂阻斷在腹腔鏡解剖性肝切除中應用的對比研究. 中華肝臟外科手術學電子雜志, 2024, 13(1): 21-26.
29.	梁琦, 丁洋, 田曉福, 等. 吲哚菁綠熒光反染聯合術中超聲引導在腹腔鏡解剖性肝切除術中的應用價值. 寧夏醫學雜志, 2025, 47(6): 475-479.
30.	董家鴻, 王繼濤, 閆軍. 精準外科理念下肝臟精細解剖臨床實踐. 中國實用外科雜志, 2025, 45(8): 871-874, 879.
31.	侯子琪, 謝青云, 廖明恒, 等. 吲哚菁綠熒光引導下腹腔鏡解剖性肝切除術的臨床效果. 中華外科雜志, 2023, 61(5): 368-374.
32.	謝青云, 雷澤華, 高峰畏, 等. “LEER”模式加速康復外科理念在腹腔鏡解剖性肝切除術中的應用. 中國普外基礎與臨床雜志, 2021, 28(3): 322-328.

1. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
2. Kale SR, Karande G, Gudur A, et al. Recent trends in liver cancer: epidemiology, risk factors, and diagnostic techniques. Cureus, 2024, 16(10): e72239. doi: 10.7759/cureus.72239.
3. Takayama T, Yamazaki S, Matsuyama Y, et al. Prognostic grade for resecting hepatocellular carcinoma: multicentre retrospective study. Br J Surg, 2021, 108(4): 412-418.
4. Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet, 1985, 161(4): 346-350.
5. 鄭博文, 鄭樹國. 腹腔鏡解剖性肝切除術治療肝細胞癌的現狀與思考. 肝癌電子雜志, 2021, 8(4): 1-5.
6. 鄭樹國, 王星入, 李建偉. 腹腔鏡肝切除術中確定和顯露肝內重要解剖標志的意義和技術要點. 中國實用外科雜志, 2025, 45(8): 875-879.
7. 張文君, 陳曉鵬. Laennec膜及其在腹腔鏡肝膽外科手術中的應用. 肝膽胰外科雜志, 2024, 36(5): 257-261, 268.
8. Hu Y, Shi J, Wang S, et al. Laennec’s approach for laparoscopic anatomic hepatectomy based on Laennec’s capsule. BMC Gastroenterol, 2019, 19(1): 194.
9. Zeng H, Zheng R, Sun K, et al. Cancer survival statistics in China 2019-2021: a multicenter, population-based study. J Natl Cancer Cent, 2024, 4(3): 203-213.
10. 王安志, 張帆, 杜京洋, 等. 腹腔鏡門靜脈流域解剖性肝切除技術發展及要點. 中國普通外科雜志, 2025, 34(1): 62-69.
11. Liu H, Hu FJ, Li H, et al. Anatomical vs nonanatomical liver resection for solitary hepatocellular carcinoma: a systematic review and meta-analysis. World J Gastrointest Oncol, 2021, 13(11): 1833-1846.
12. 任思謙, 陳晴, 原春輝. 肝臟的解剖學研究進展. 中華外科雜志, 2019, 57(7): 551-553.
13. 陳雷, 黃徐建, 陶計林, 等. 精準熒光導航: 吲哚菁綠在腹腔鏡解剖性肝切除術中的應用效果. 中國普外基礎與臨床雜志, 2025, 32(8): 978-983.
14. Wang SD, Wang L, Xiao H, et al. Novel techniques of liver segmental and subsegmental pedicle anatomy from segment 1 to segment 8. World J Gastrointest Surg, 2024, 16(12): 3806-3817.
15. 楊陳鳳麟, 李堯, 王鑫, 等. “門理論”在微創解剖性肝切除術中的應用與展望. 中國實用外科雜志, 2024, 44(3): 341-345.
16. Sugioka A, Kato Y, Tanahashi Y. Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec’s capsule: proposal of a novel comprehensive surgical anatomy of the liver. J Hepatobiliary Pancreat Sci, 2017, 24(1): 17-23.
17. 中國研究型醫院學會肝膽胰外科專業委員會, 《中華消化外科雜志》編輯委員會. 腹腔鏡解剖性肝切除手術操作流程及技術標準中國專家共識 (2023版). 中華消化外科雜志, 2023, 22(7): 810-823.
18. 王曉穎. 腹腔鏡解剖性肝切除術中熒光染色意外及對策. 中國實用外科雜志, 2022, 42(9): 1001-1004.
19. 季軍, 黃紀偉. 吲哚菁綠熒光染色技術在解剖性肝切除術中的應用現狀. 腹部外科, 2025, 38(1): 7-11.
20. 路志宇, 孫驥, 杜加錄, 等. 腹腔鏡解剖性半肝切除中肝蒂處理與吲哚菁綠劑量影響熒光染色效果的研究. 外科理論與實踐, 2024, 29(2): 138-142.
21. 王曉穎. 吲哚菁綠熒光成像技術在肝臟外科應用中國專家共識 (2023版). 中國實用外科雜志, 2023, 43(4): 371-383.
22. 劉杰, 成劍. 肝癌腹腔鏡解剖性肝切除術的若干問題再議. 肝膽胰外科雜志, 2020, 32(5): 265-269.
23. Yang Y, Yu CY, Lin F, et al. Application of Laennec extrathecal blockade combined with indocyanine green fluorescence imaging in laparoscopic anatomic hepatectomy. ANZ J Surg, 2024, 94(4): 655-659.
24. 余德才. 肝臟膜性解剖及Laennec入路解剖性肝切除. 中華腔鏡外科雜志 (電子版), 2019, 12(6): 332-336.
25. 《中華消化外科雜志》編輯委員會, 中國研究型醫院學會肝膽胰外科專業委員會. 腹腔鏡門靜脈流域解剖性肝切除理論及技術標準中國專家共識 (2023版). 中華消化外科雜志, 2023, 22(12): 1385-1397.
26. Hu M, Chen Z, Xu D, et al. Efficacy and safety of indocyanine green fluorescence navigation versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis. Surg Endosc, 2025, 39(3): 1681-1695.
27. Li B, Yin D, Zhang Q, et al. Laennec approach for anatomical liver resection assisted by laparoscopy or robotics: a multicenter cohort study. Int J Surg, 2025, 111(2): 1929-1938.
28. 洪漢崟, 陳志堅, 池小斌, 等. 鞘外法和鞘內法Glisson蒂阻斷在腹腔鏡解剖性肝切除中應用的對比研究. 中華肝臟外科手術學電子雜志, 2024, 13(1): 21-26.
29. 梁琦, 丁洋, 田曉福, 等. 吲哚菁綠熒光反染聯合術中超聲引導在腹腔鏡解剖性肝切除術中的應用價值. 寧夏醫學雜志, 2025, 47(6): 475-479.
30. 董家鴻, 王繼濤, 閆軍. 精準外科理念下肝臟精細解剖臨床實踐. 中國實用外科雜志, 2025, 45(8): 871-874, 879.
31. 侯子琪, 謝青云, 廖明恒, 等. 吲哚菁綠熒光引導下腹腔鏡解剖性肝切除術的臨床效果. 中華外科雜志, 2023, 61(5): 368-374.
32. 謝青云, 雷澤華, 高峰畏, 等. “LEER”模式加速康復外科理念在腹腔鏡解剖性肝切除術中的應用. 中國普外基礎與臨床雜志, 2021, 28(3): 322-328.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The application value of extra-sheath dissection via the Laennec membrane space combined with indocyanine green fluorescence in laparoscopic anatomical hepatectomy

Abstract Full text Figures/Tables Video References Cited by

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