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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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

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Abbreviations

PCLD:

Polycystic liver disease

IGFI:

Indocyanine green fluorescence imaging

ICG:

Indocyanine green

ICG-R15:

Indocyanine green retention rate at 15 min

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Acknowledgments

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.

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Disclosures

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.

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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.

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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). https://doi.org/10.1007/s00464-015-4526-x

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Keywords

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