fig5

Figure 5. These images demonstrate the preoperative planning for a segment 7 resection and intraoperative hepatectomy views. (A) This image is a posterior view of the liver that demonstrates the location of the tumor (colored pink) and the segment 7 inflow pedicle highlighted in purple that branches; (B) This is an anterior view, whereby the segment 7 pedicle is poorly visualized due to its posterior and deep take-off. The segment 7 boundary is highlighted brown, and the segment 6 boundary is highlighted green. A segment 7 resection is deemed feasible for surgical margins. The segment 7 pedicle, in this case, is best accessed via a hepatotomy rather than from the hilum due to its posterior and deep take-off; (C) A hepatotomy is performed along the posterior surface of the liver adjacent to the inferior vena cava for intra-parenchymal isolation of the segment 7 inflow pedicle. The pedicle is doubly clamped to confirm the ischemic demarcation; (D) Systemic ICG is then administered for negative staining of segment 7. Liver parenchyma transection then proceeds along the demarcation line with ICG-overlay guidance. ICG: Indocyanine green.