ICG guided simultaneous laparoscopic colectomy and major hepatectomy

Purpose: Surgical resection in one stage of primary colon cancer and synchronous liver metastases is an acceptable option. However, it causes significant surgical stress with high perioperative morbidity. The use minimally invasive surgery techniques could ameliorate this effect. We report a case simultaneous laparoscopic sigmoidectomy left hepatectomy using ICG fluorescence-guided techniques. Method: 86 years old female patient was referred to our unit for management colorectal located the sigmoid single hepatic metastasis measuring 6 cm between middle vein (seg. IVa). underwent neoadjuvant treatment six cycles FOLFOX, which led response (max. diameter reduced 4 cm). A decided. Material: 24 hours before surgery, 5 mg iv injected into patient. Firstly after introducing first trocar pneumoperitoneum complete mesocolic excision end anastomosis circular stapler performed. After that, visualized by switching mode tumour identified. Hilar dissection performed artery, portal were found ligated hemo lock. demarcation line optical imaging system injecting 2,5 iv. Liver transection Cusa, harmonic scalpel, intermittent Pringle manoeuvre fifteen min on five off. duct also confirmed under guidance stapler. Both specimens removed through Pfannenstiel incision. Total operation time 3 hours, estimated blood loss 300cc. postoperative course uneventful, discharged 5th day. Conclusion: Simultaneous colectomy major are challenging operations that should be only experienced centres can reduce helps locate tumour, correct line, biliary structures vascular anastomotic perfusion bowel anastomosis.