%0 Journal Article
%T Real-Time Fluorescent Cholangiography by Intrabiliary Indocyanine Green Administration With Near-Infrared Laparoscopy in Major Hepatectomy.
%A Sasaki N
%A Okamura Y
%A Nishitai R
%J Cureus
%V 15
%N 6
%D 2023 Jun
%M 37485116
暂无%R 10.7759/cureus.40769
%X <B>OBJECTIVE: </B>Biliary injury is a severe complication that can be associated with liver surgery. Intrahepatic biliary anatomy can be evaluated using magnetic resonance cholangiopancreatography and X-ray cholangiography; however, an intraoperative real-time bile duct visualization method has not yet been reported. This study aimed to demonstrate the availability of real-time fluorescent cholangiography (FC) by intrabiliary indocyanine green administration with near-infrared laparoscopy in major hepatectomy.<BR><B>METHODS: </B>The optimal concentration of indocyanine green (ICG) solution was examined ex vivo. The fluorescence intensity of the ICG solution and its mixture with bile was measured. Using a clinical trial model, ICG solution was injected into the cystic duct, followed by near-infrared laparoscopy performed during hepatectomy.<BR><B>RESULTS: </B>The optimal concentration of ICG solution for FC was between 0.01 and 0.05 mg/mL. Three different laparoscopic systems were used in three hepatectomy cases. In all cases, the fluorescence of the intrahepatic bile ducts in the Glissonian sheath was clearly visualized using the near-infrared laparoscopic system. A small piece of tissue prevented the bile glow; thus, exposure of the Glissonian sheath was necessary for clear FC. This procedure also detected bile leakage from the cut surface of the liver.<BR><B>CONCLUSIONS: </B>Intrabiliary ICG administration and near-infrared laparoscopy enabled real-time intrahepatic FC during major hepatectomy.