Indocyanine green fluorescence imaging via endoscopic nasal biliary drainage during laparoscopic deroofing of liver cysts
Akira Umemura1, Hiroyuki Nitta2, Takayuki Suto3, Hisataka Fujiwara3, Takeshi Takahara2, Yasushi Hasegawa2, Hirokatsu Katagiri2, Shoji Kanno2, Taro Ando2, Akira Sasaki2
1 Department of Surgery, Iwate Medical University, Iwate; Department of Surgery, Morioka Municipal Hospital, Morioka, Japan
2 Department of Surgery, Iwate Medical University, Iwate, Japan
3 Department of Surgery, Morioka Municipal Hospital, Morioka, Japan
2-1-1 Idaidori, Yahaba, Iwate, 028-3695
Source of Support: None, Conflict of Interest: None
Laparoscopic deroofing of liver cysts is widely accepted as the treatment of symptomatic huge liver cysts. As bile leakage is a common complication of this procedure, indocyanine green (ICG) imaging has played an active role in detecting intrahepatic biliary tract. However, infusion ICG imaging needs time rag after injection due to moving from bloodstream to bile, and also, additional injection is needed when the fluorescent imaging is not clear. To cover this weakness of ICG imaging, we first applied ICG imaging via 5-Fr endoscopic nasal biliary drainage (ENBD) during laparoscopic deroofing of liver cysts. This technique promptly gives us ICG imaging after ICG injection from ENBD; in addition, direct ICG imaging sometimes reveals minor leakage from sealing line and staple lines; therefore, we believe that direct ICG imaging via ENBD helps us to prevent post-operative bile leakage.