title: Sustained methylene blue staining to guide anatomic hepatectomy for hepatocellular carcinoma: Initial experience and technical details.
abstract: BACKGROUND
  The boundary of the target hepatic segment within the liver parenchyma cannot be marked by the use of a conventional anatomic hepatectomy approach. This study describes a novel methylene blue staining technique for guiding the anatomic resection of hepatocellular carcinoma (HCC).
  
  
  METHODS
  Between February 2009 and February 2012, anatomic hepatectomy was performed in 106 patients with HCC via a novel, sustained methylene blue staining technique. Sustained staining was achieved by injecting methylene blue into the distal aspect of the portal vein after exposing Glisson's sheath. The hepatic pedicle was immediately ligated, and the hepatic parenchymal transection was performed along the interface between methylene blue stained tissue and unstained tissue.
  
  
  RESULTS
  Anatomic hepatectomies included subsegmentectomy (n = 16), monosegmentectomy (n = 57), multisegmentectomy (n = 27), and hemihepatectomy (n = 6). The portal vein was injected successfully with methylene blue in 100% of cases, and complete staining of the target hepatic segment was achieved in 98 of 106 (92.5%) cases. Mean intraoperative bleeding was 360 ± 90 mL, and the postoperative complication rate was 24.5% (26/106). No perioperative mortality occurred. Operative margins were all negative on pathologic examination. Mean duration of postoperative follow-up was 40 months (range, 24-60). No local recurrence (around the operative margin) occurred.
  
  
  CONCLUSIONS
  This novel technique of achieving sustained staining by injecting methylene blue then immediately ligating the hepatic pedicle is simple and feasible. It can guide the selection of the operative margin during hepatic parenchyma transection to improve the accuracy of anatomic hepatectomy for the treatment of HCC.
authors: Institute & Hospital of Hepatobiliary Surgery, General Hospital of PLA, Beijing, China.
authors: Cai
authors: C
authors: Shou-wang
authors: Department of Hepatobiliary Surgery, 401 Hospital of PLA, Qingdao, China.
authors: Yang
authors: Y
authors: Shi-zhong
authors: Institute & Hospital of Hepatobiliary Surgery, General Hospital of PLA, Beijing, China.
authors: Lv
authors: L
authors: Wen-ping
authors: Institute & Hospital of Hepatobiliary Surgery, Southwest Hospital, the Third Military Medical University, Chongqing, China.
authors: Chen
authors: C
authors: Geng
authors: Institute & Hospital of Hepatobiliary Surgery, General Hospital of PLA, Beijing, China.
authors: Gu
authors: G
authors: Wan-qing
authors: Institute & Hospital of Hepatobiliary Surgery, General Hospital of PLA, Beijing, China.
authors: Duan
authors: D
authors: Wei-dong
authors: Institute & Hospital of Hepatobiliary Surgery, General Hospital of PLA, Beijing, China.
authors: Wang
authors: W
authors: Wei-yi
authors: Institute & Hospital of Hepatobiliary Surgery, General Hospital of PLA, Beijing, China.
authors: Huang
authors: H
authors: Zhi-qiang
authors: Institute & Hospital of Hepatobiliary Surgery, General Hospital of PLA, Beijing, China. Electronic address: dongjh301@163.com.
authors: Dong
authors: D
authors: Jia-hong
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery*; D008099:Liver / Q000098:blood supply / Q000473:pathology*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue