Usefulness of Indocyanine Green Fluorescence-Guided Surgery for Simultaneous Laparoscopic Hepatic Cyst Fenestration and Cholecystectomy.

Indocyanine green is a fluorescent dye excreted in bile that enables clear visualization of biliary anatomy during surgery. Laparoscopic hepatic cyst fenestration and cholecystectomy can cause bile leakage and bile duct injury. Real-time indocyanine green fluorescence-guided surgery has the potential to reduce these risks. We report a case of a 74-year-old woman with an 11 cm hepatic cyst and cholelithiasis who underwent simultaneous laparoscopic hepatic cyst fenestration and cholecystectomy with indocyanine green guidance. The minor intraoperative bile leak, undetectable during hepatic cyst fenestration, was later identified by indocyanine green fluorescence after cholecystectomy. This case report highlights the potential of indocyanine green fluorescence to detect minor bile leaks difficult to see under white light and suggests clinical benefits of performing hepatic cyst fenestration before cholecystectomy.