To summarize the methods of real-time localization of tumor and judgment of residual liver function of indocyanine green (ICG) in robotic target resection of small hepatocellular carcinoma (sHCC).

The perioperative data of patients who underwent robotic resection of sHCC (≤5 cm) from May 2021 to Mar. 2022 were retrospectively analyzed. Forty-eight hours before operation, ICG was injected through the median elbow vein in all the patients at a dose of 0.25 mg/kg. In the robot fluorescence mode, the tumor boundary was located in real time by ICG fluorescence development. After tumor resection, ICG was injected again through peripheral vein of patients to judge the residual liver blood supply.

There were 12 patients in this study, including 10 males and 2 females, with an average age of 56.3 years. The average diameter of tumor was (3.3±1.09) cm, and the median operation time was 75 min, and the median blood loss was 50 ml, and the average postoperative hospital stay was 4.9 days. During the operation, all tumors displayed green fluorescent, the fluorescent effect had nothing to do with the degree of tumor differentiation, and the internal bleeding and necrosis of the tumor did not displayed green fluorescent. ICG fluorescence imaging began to appear in the ischemic part of the liver tissue around the surgical margin 5 minutes after the removal of the hepatic portal occlusion. There was no residual liver ischemia and necrosis in all patients.

ICG fluorescence imaging can guide the robotic target resection of sHCC and judge the residual liver blood supply in real time.