Takeyuki Misawa, MD, PhD, Shuichi Fujioka, MD, Hiroaki Kitamura, MD, Yu Kumagai, MD, Tadashi Akiba, MD. The Jikei University Kashiwa Hospital
Background and Aim: Though laparoscopic deroofing is widely applied for the management of symptomatic giant hepatic cysts, bile leakage remains as the most troublesome and common complication. Herein, we verified the feasibility of indocyanine green fluorescent imaging (IGFI) for identifying intrahepatic biliary branches and avoiding bile leakage after deroofing of giant hepatic cysts.
Methods: For patients with symptomatic hepatic cysts, preoperative multi-detector row computed tomography (CT) and prolonged drip infusion CT cholangiography (DIC-CT) were routinely performed in our department to deny possible malignancy or communication between the cysts and the biliary tract. IGFI system used in this study consists of a charge-coupled device camera (410,000 pixels) and a xenon light source (Olympus Medical Systems, Tokyo, Japan).
Case: A 70-year-old woman with complaints of abdominal distension and persistent abdominal dullness was referred to our department to undergo laparoscopic deroofing for giant hepatic cysts. Immediately after endotracheal intubation, 1 ml of indocyanine green (2.5mg) was intravenously administered. Under four-trocar setting, the fluid contents of the cysts were completely aspirated by a double balloon catheter (Hakko, Tokyo, Japan). Then, laparoscopic deroofing of the cyst wall was performed mainly using a vessel sealing device under the normal view mode. IGFI mode was occasionally used to identify the biliary branches on the cyst wall. After completion of wide deroofing, a flat drain was placed in the left subphrenic space.
Results: Laparoscopic deroofing was successfully completed for two giant cysts without any intraoperative complications. The operation time was 196 minutes, and the amount of intraoperative blood loss was minimal (uncountable) due to the effective use of the vessel sealers. Since IGFI mode definitively enabled the detection of even small biliary branches on the cyst wall, they were securely stapled and transected. The patient was uneventfully discharged on the fifth postoperative day.
Conclusion: IGFI enabled real-time identification of intrahepatic bile ducts, thus contributing to the prevention of bile leakage after laparoscopic deroofing of giant hepatic cysts.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79941
Program Number: P447
Presentation Session: Poster (Non CME)
Presentation Type: Poster