Application of Indocyanine Green Fluorescence Imaging Technology in Laparoscopic Duodenum-Preserving Pancreatic Head Resection.

This protocol aims to demonstrate the integration of indocyanine green (ICG) fluorescence imaging into laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) to enable real-time visualization of the biliary tree and minimize the risk of common bile duct (CBD) injury. Adult patients with benign or low-grade malignant tumors of the pancreatic head are selected. Preoperatively, 5 mg of ICG is administered intravenously to achieve optimal hepatic uptake and biliary excretion. During LDPPHR, a near-infrared camera system is employed to detect fluorescence and delineate the CBD and its anatomical relationships. Trocars are placed to optimize instrument access, and stepwise dissection exposes the pancreas and biliary tract. Fluorescence imaging guides precise skeletonization and protection of the CBD during pancreatic head separation. The pancreatic neck is divided using ultrasonic energy; reconstruction is performed via duct-to-mucosa pancreaticojejunostomy. Intraoperative ultrasound is utilized as an adjunct to confirm anatomical margins and vascular proximity. Postoperative management includes drain placement and monitoring guided by amylase measurements. In a series of six patients, this protocol enabled accurate biliary identification, prevented bile duct injury, and was associated with favorable outcomes. This fluorescence-guided technique enhances surgical safety and may facilitate the adoption of organ-preserving strategies in selected pancreatic head lesions.