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Indocyanine green fluorescence–guided laparoscopic anatomical hepatectomy for radical resection of hepatocellular carcinoma: a clinical study

Year: 2026

Type: article

Abstract: INTRODUCTION: Anatomical hepatectomy improves outcomes in hepatocellular carcinoma (HCC), but remains technically demanding laparoscopically. Indocyanine green (ICG) fluorescence may aid navigation, yet its clinical value remains unproven. AIM: We aimed to evaluate whether ICG-guided laparoscopic anatomical hepatectomy improved resection quality and short-term outcomes, as compared with conventional high-definition laparoscopy. MATERIALS AND METHODS: In this single-center, prospective, open-label, parallel-group randomized controlled trial (October 2023-December 2025), 100 patients with resectable primary HCC were randomized at a 1:1 ratio to the ICG-guided laparoscopic anatomical hepatectomy (n = 50) or conventional laparoscopy (n = 50) cohorts. The ICG protocol included preoperative intravenous ICG plus intraoperative ultrasound-guided positive / negative staining. Primary outcomes were anatomical resection and R0 rates. Secondary outcomes included blood loss, complications, 1-year disease-free survival (DFS), and overall survival (OS). RESULTS: = 0.07). CONCLUSIONS: ICG fluorescence-guided laparoscopic anatomical hepatectomy is safe and feasible, significantly improving radical resection quality with more anatomical dissections, higher R0 rates, wider margins, and fewer complications, as compared with the conventional approach. Longer follow-up is needed to confirm survival benefits.

Source: Videosurgery and Other Miniinvasive Techniques

DOI: 10.20452/wiitm.2026.18047