Laparoscopic deroofing for polycystic liver disease using laparoscopic fusion indocyanine green fluorescence imaging



Laparoscopic deroofing is widely used for the treatment of symptomatic polycystic liver disease (PCLD). However, bile leakage is a common complication of surgical management for PCLD. Until now, indocyanine green fluorescence imaging (IGFI) has played an active role in hepatobiliary surgery. Herein, we report the effective application of a laparoscopic fusion IGFI system, known as PINPOINT, for laparoscopic deroofing.


In this study, we performed laparoscopic deroofing for PCLD using the laparoscopic fusion IGFI system. We conducted the procedure mainly under the normal view mode, occasionally switching to the fusion IGFI mode. First, we confirmed that the liver cysts did not contain bile using the fusion IGFI mode and then used a percutaneous puncture needle to remove the fluid from some of the giant cysts. Second, using the fusion IGFI mode, we were able to detect thin biliary branches and to adjust the division line of the cyst wall accordingly or, occasionally, to ligate the branches. Finally, we searched for and identified unexpected small bile leakage and then closed it using sutures.


The laparoscopic fusion IGFI system can simultaneously show fluorescent images, such as cholangiography and the liver parenchyma, on the normal color view. In the fusion IGFI mode, the intrahepatic bile duct and liver parenchyma can be easily discriminated in real time throughout the procedure. Accordingly, the laparoscopic fusion IGFI system is useful for the surgical treatment of PCLD, in which the boundary between the liver cysts and the liver parenchyma can otherwise be difficult to identify. This technique also enables the branches of Glisson’s capsule to be identified without any other intervention.


The novel application of the laparoscopic fusion IGFI system allows reliable navigation for PCLD surgery.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA



Polycystic liver disease


Indocyanine green fluorescence imaging


Indocyanine green


Indocyanine green retention rate at 15 min


  1. 1.

    Ogawa K, Fukunaga K, Takeuchi T, Kawagishi N, Ubara Y, Kudo M, Ohkohchi N (2013) Current treatment status of polycystic liver disease in Japan. Hepatol Res 44:1110–1118

  2. 2.

    Ardito F, Bianco G, Vellone M, Sarno G, Ranucci G, Giovannini I, Giuliante F (2013) Long-term outcome after laparoscopic fenestration of simple liver cysts. Surg Endosc 27:4670–4674

  3. 3.

    Yamada T, Furukawa K, Yokoi K, Mamada Y, Kanazawa Y, Tajiri T (2009) Liver cysts with biliary communication successfully treated with laparoscopic deroofing. A case report. J Nippon Med Sch 76:103–108

  4. 4.

    Imamura H, Kawashita Y, Koga N, Sanada Y, Azuma T, Matsuo S, Eguchi S (2013) A large hepatic cyst with obstructive jaundice successfully treated with single-incision laparoscopic deroofing. Case Rep Gastroenterol 7:503–510

  5. 5.

    Szabo LS, Takacs I, Arkosy P, Sapy P, Szentkereszty Z (2006) Laparoscopic treatment of nonparasitic hepatic cysts. Surg Endosc 20:595–597

  6. 6.

    Qiu JG, Wu H, Jiang H, Huang JW, Pankaj P, Xu YL, Wang JZ, Zeng Y (2011) Laparoscopic fenestration vs open fenestration in patients with congenital hepatic cysts: a meta-analysis. World J Gastroenterol 17:3359–3365

  7. 7.

    Zaharie F, Bartos D, Mocan L, Zaharie R, Iancu C, Tomus C (2013) Open or laparoscopic treatment for hydatid disease of the liver? A 10-year single-institution experience. Surg Endosc 27:2110–2116

  8. 8.

    Coelho-Prabhu N, Nagorney DM, Baron TH (2012) ERCP for the treatment of bile leak after partial hepatectomy and fenestration for symptomatic polycystic liver disease. World J Gastroenterol 18:3705–3709

  9. 9.

    Hansman MF, Ryan JA, Holmes JH, Hogan S, Lee FT, Kramer D, Biehl T (2001) Management and long-term follow-up of hepatic cysts. Am J Surg 181:404–410

  10. 10.

    Cui W, Zhou HY, Zhang YH, Zhang T, Li Q (2013) Surgical management of non-parasitic hepatic cyst with biliary communication: a case report. Cancer Biol Med 10:110–113

  11. 11.

    Ishizawa T, Bandai Y, Ijichi M, Kaneko J, Hasegawa K, Kokudo N (2010) Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy. Br J Surg 97:1369–1377

  12. 12.

    Morita K, Ishizawa T, Tani K, Harada N, Shimizu A, Yamamoto S, Takemura N, Kaneko J, Aoki T, Sakamoto Y, Sugawara Y, Hasegawa K, Kokudo N (2014) Application of indocyanine green-fluorescence imaging to full-thickness cholecystectomy. Asian J Endosc Surg 7:193–195

  13. 13.

    Ishizawa T, Kaneko J, Inoue Y, Takemura N, Seyama Y, Aoki T, Beck Y, Sugawara Y, Hasegawa K, Harada N, Ijichi M, Kusaka K, Shibasaki M, Bandai Y, Kokudo N (2011) Application of fluorescent cholangiography to single-incision laparoscopic cholecystectomy. Surg Endosc 25:2631–2636

  14. 14.

    Kawaguchi Y, Ishizawa T, Masuda K, Sato S, Kaneko J, Aoki T, Beck Y, Sugawara Y, Hasegawa K, Kokudo N (2011) Hepatobiliary surgery guided by a novel fluorescent imaging technique for visualizing hepatic arteries, bile ducts, and liver cancers on color images. J Am Coll Surg 212:e33–e39

  15. 15.

    Ishizawa T, Tamura S, Masuda K, Aoki T, Hasegawa K, Imamura H, Beck Y, Kokudo N (2009) Intraoperative fluorescent cholangiography using indocyanine green: a biliary road map for safe surgery. J Am Coll Surg 208:e1–e4

  16. 16.

    Inoue Y, Arita J, Sakamoto T, Ono Y, Takahashi M, Takahashi Y, Kokudo N, Saiura A (2015) Anatomical liver resection guided by 3-dimensional parenchymal staining using fusion indocyanine green fluorescence imaging. Ann Surg (Epub ahead of print)

  17. 17.

    Cherrick GR, Stein SW, Leevy CM, Davidson CS (1960) Indocyanine green: observations on its physical properties, plasma decay, and hepatic extraction. J Clin Investig 39:592–600

  18. 18.

    Yano K, Nimura H, Mitsumori N, Takahashi N, Kashiwagi H, Yanaga K (2012) The efficiency of micrometastasis by sentinel node navigation surgery using indocyanine green and infrared ray laparoscopy system for gastric cancer. Gastric Cancer 15:287–291

  19. 19.

    Ishizawa T, Masuda K, Urano Y, Kawaguchi Y, Satou S, Kaneko J, Hasegawa K, Shibahara J, Fukayama M, Tsuji S, Midorikawa Y, Aburatani H, Kokudo N (2014) Mechanistic background and clinical applications of indocyanine green fluorescence imaging of hepatocellular carcinoma. Ann Surg Oncol 21:440–448

  20. 20.

    Ishizawa T, Fukushima N, Shibahara J, Masuda K, Tamura S, Aoki T, Hasegawa K, Beck Y, Fukayama M, Kokudo N (2009) Real-time identification of liver cancers by using indocyanine green fluorescent imaging. Cancer 115:2491–2504

  21. 21.

    Kudo H, Ishizawa T, Tani K, Harada N, Ichida A, Shimizu A, Kaneko J, Aoki T, Sakamoto Y, Sugawara Y, Hasegawa K, Kokudo N (2014) Visualization of subcapsular hepatic malignancy by indocyanine-green fluorescence imaging during laparoscopic hepatectomy. Surg Endosc 28:2504–2508

  22. 22.

    Ris F, Hompes R, Cunningham C, Lindsey I, Guy R, Jones O, George B, Cahill RA, Mortensen NJ (2014) Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery. Surg Endosc 28:2221–2226

Download references


Yosuke Inoue participated in the operation and supervised the writing of the paper. Yoshihiro Mise, Takeaki Ishizawa, and Yu Takahashi also supervised the writing of the paper. Akio Saiura represents our surgical department and supervised the writing of the paper.

Author information

Correspondence to Akio Saiura.

Ethics declarations


Masayuki Tanaka, Yosuke Inoue, Yoshihiro Mise, Takeaki Ishizawa, Junichi Arita, Yu Takahashi and Akio Saiura read and approved the final manuscript and declare that they have no conflicts of interest or financial ties to disclose.

Informed consent

Written informed consent was obtained from the patient for the publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 2 (WMV 45426 kb)

Supplementary material 1 (DOCX 11 kb)

Supplementary material 2 (WMV 45426 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tanaka, M., Inoue, Y., Mise, Y. et al. Laparoscopic deroofing for polycystic liver disease using laparoscopic fusion indocyanine green fluorescence imaging. Surg Endosc 30, 2620–2623 (2016).

Download citation


  • PCLD
  • Laparoscopic deroofing
  • ICG
  • Laparoscopic fusion of indocyanine green fluorography imaging