Laparoscopic fenestration of liver cyst using Indocyanine-green fluorescent cholangiography

Koji Minami, Masahiko Sakoda, Satoshi Iino, Kiyokazu Hiwatashi, Kosei Maemura, Yuko Mataki, Hiroshi Kurahara, Yota Kawasaki, Shinichiro Mori, Hiroyuki Shinchi, Shinichi Ueno, Shoji Natsugoe. Kagoshima University

Liver cyst is benign disease , but it is needed a surgical treatment when there are symptoms such as the abdominal distension. Laparoscopic fenestration is useful surgical treatment of this disease, but bile duct injury is one of the intraoperative complications that should be careful .In addition, there are some case that bile duct could not be detected because of compression by the huge or multiple liver cyst .We report the case of a polycystic disease of liver for which we performed laparoscopic fenestration using intraoperative fluorescent cholangiography with indocyanine-green.

?Case?In July 2004,a 45-year-old woman was pointed out multiple cyst of liver by follow-up during pregnancy, and was diagnosed as polycystic disease by close examination. She was followed up regularly. In March 2014, She was consulted our department for surgical treatment, because of abdominal distension. We planned Operation.

?Operation Method?ICG(2.5mg/body ) was infused one hour before surgery. We added small skin incision to the naval direct top. We did fenestration directly to make space. We shifted to laparoscopic surgery by using EZ Access system. We could detected bile duct by using ICG-Fluorescent laparoscopy during operation . It was useful to detect the narrowed bile duct and, we could carried out fenestration safely.

?Discussion and conclusion?Laparoscopic fenestration is useful treatment of liver cyst, but bile duct injury is one of the complication  which should be careful. To detect the bile duct, we make preoperative examination routinely such as MRCP or DIC-CT.  But there are some cases that the biliary duct could not be detected because of compression by the huge or multiple cyst.   In present case, it was useful to detect bile duct during operation by using intraoperative ICG-fluorescent cholangiography. Fluorescent cholangiography using indocyanine-green is effective procedure to detect bile duct during laparoscopic fenestration