title: Laparoscopic deroofing for polycystic liver disease using laparoscopic fusion indocyanine green fluorescence imaging.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  The novel application of the laparoscopic fusion IGFI system allows reliable navigation for PCLD surgery.
authors.affiliation: Department of HBP Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of HBP Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of HBP Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mise
authors.affiliation: Department of HBP Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ishizawa
authors.affiliation: Department of HBP Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Arita
authors.affiliation: Department of HBP Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of HBP Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. akio.saiura@gmail.com.
authors.forename: Akio
authors.initials: A
authors.lastname: Saiura
mesh_terms: D000369:Aged, 80 and over; D003560:Cysts / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D010535:Laparoscopy / Q000379:methods*; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D061848:Optical Imaging / Q000379:methods*
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green
keywords: ICG; Laparoscopic deroofing; Laparoscopic fusion of indocyanine green fluorography imaging; PCLD; PINPOINT