ArticleSurgical endoscopy2026
Application of indocyanine green fluorescence for hilar bile duct identification and management in laparoscopic hemi-hepatectomy (with video).
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Abstract
backgroundLaparoscopic hemi-hepatectomy using the individual transection method (ITM) for tumors with hilar involvement is technically challenging due to the complex biliary anatomy. Indocyanine green (ICG) fluorescence cholangiography has the potential to improve intraoperative bile duct visualization; however, its clinical value in this setting has not been well established.
methodsWe retrospectively reviewed 31 patients who underwent laparoscopic hemi-hepatectomy between July 2020 and September 2024. The Glissonean pedicle method (GPM) was used when secondary Glissonean branches were not involved, while the ITM was selected for tumors involving their confluence. ICG fluorescence cholangiography was employed in all cases treated with the ITM. Surgical outcomes and bile duct visualization were assessed using a three-grade Bile Duct Visualization Score (BDVS).
resultsThirteen patients underwent laparoscopic hemi-hepatectomy using the ITM with ICG guidance. The median operative time in the ITM group was longer in comparison to the GPM group (425 vs. 334 min, p = 0.026), while the median blood loss was similar between the groups (101 vs. 174 mL, p = 0.968). Right hemi-hepatectomy was more frequently performed in the ITM group (n = 8 vs. n = 4), whereas left hemi-hepatectomy was predominant in the GPM group (n = 5 vs. n = 14; p = 0.027). According to the BDVS, 77% of ITM cases were classified as "clearly visible" (score 2). R0 resection was achieved in all cases. One case each of biliary stenosis and postoperative bile fistula was observed in the ITM group, both were managed non-surgically. No 90-day mortality occurred.
conclusionsICG fluorescence cholangiography enabled reliable visualization of the hilar bile ducts and contributed to safe bile duct management in laparoscopic hemi-hepatectomy requiring application of the ITM. This technique provides useful support when performing laparoscopic liver resections in challenging cases.
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