Indocyanine Green Fluorescence Imaging–Assisted Laparoscopic Radiofrequency Ablation of Hepatocellular Carcinoma

A 61-year-old male hepatitis B carrier was noted to have a hypoechoic mass at liver dome during ultrasonographic surveillance. Subsequent triphasic magnetic resonance imaging revealed a hyperenhanced tumor measuring approximately 2 cm in diameter at segment 7 of the liver during the arterial phase (Figure A). Percutaneous radiofrequency ablation (RFA) was abandoned because preprocedural ultrasonography failed to localize the lesion. The patient opted to undergo RFA through laparoscopic approach with the assistance of indocyanine green (ICG) fluorescence imaging. After adequate mobilization of the right liver and moving the camera to a right upper quadrant port, the tumor that was not visualized under white light emitted homogeneous ICG fluorescence under infrared light (Figures B and C). Appropriate positioning of the RFA electrode was confirmed by intraoperative ultrasonography (Figure D) and the tumor was successfully ablated. Pathologic examination revealed a well-differentiated hepatocellular carcinoma. The patient recovered uneventfully and remained recurrence-free during follow-up. Although most ablative procedures are performed through the percutaneous approach, laparoscopic approach may be considered for tumors at difficult or risky locations. Because hepatocellular carcinoma may emit ICG fluorescence under infrared light, such imaging technique may facilitate localization during laparoscopic RFA.