ObjectiveTo evaluate the effects of indocyanine green (ICG) fluorescence imaging in laparoscopic anatomic hepatectomy. MethodsThe clinical data of 26 patients who underwent ICG fluorescence-guided laparoscopic anatomic hepatectomy in the Department of Hepatobiliary Surgery at Affiliated Hospital of North Sichuan Medical College from March 2019 to May 2023 were retrospectively analyzed. ICG staining methods included combined lipiodol-ICG (SHIFT&nanoICG) hepatic artery embolization (anterograde staining) and (or) portal vein retrograde staining. Patient demographics, pathological characteristics, intraoperative outcomes (ICG staining method and results, operation time, intraoperative blood loss, transfusion rate, conversion to open surgery), and postoperative outcomes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), total bilirubin (TB) levels on postoperative day 3, hospital stay, complications] were analyzed. Quantitative data conforming to a normal distribution were described as mean ± standard deviation, while skewed distributions were described as median (interquartile range). The significance level was set at α=0.05. ResultsAmong 26 patients, 6 received combined anterograde (SHIFT&nanoICG) + retrograde staining (referred to as the “dual-staining group”), while 20 received retrograde staining alone (referred to as the “single-staining group”). One case (3.8%) in the single-staining group required conversion to open surgery. All resection margins were negative. No statistically significant differences were observed between the dual-staining group and the single-staining group for the following parameters: Tumor diameter [5.0 (4.4) cm vs. 4.0 (4.2) cm, P=0.483], operative time [307.0 (146.0) min vs. 250.0 (137.5) min, P=0.831], intraoperative blood loss [250.0 (225.0) mL vs. 225.0 (338.0) mL, P=0.756], postoperative hospital stay [(12.3±2.1) d vs. (10.9±2.7) d, P=0.232]. Furthermore, no significant differences were found in ALT, AST, ALB, and TB levels on postoperative day 3 (P>0.05). Regarding postoperative complications (classified according to the Clavien-Dindo system): One patient with grade Ⅰ complication was recorded in the dual-staining group, 3 with grade Ⅰ and 3 with grade Ⅱ complications were recorded in the single-staining group, no grade Ⅲ or higher complications occurred in either group. Comparison of complication rate between the two groups showed no statistically significant difference (P=0.600). ConclusionsBoth conventional ICG and SHIFT&nanoICG provide effective fluorescence guidance for laparoscopic anatomic hepatectomy. For patients with hepatocellular carcinoma who are ineligible for primary radical resection or have lost the opportunity for initial curative surgery, SHIFT&nanoICG provides superior intraoperative fluorescence visualization following transarterial embolization-assisted conversion therapy.