Quantitative indocyanine green fluorescence imaging in laparoscopic duodenum-preserving pancreatic head resection.

BACKGROUND

Laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) is technically demanding. We developed a quantitative indocyanine green fluorescence imaging protocol (q-ICG) to assist LDPPHR and evaluated its clinical utility.

METHODS

We retrospectively analyzed 72 patients who underwent LDPPHR between 2019 and 2025. Patients were divided into a q-ICG group (n = 35) and a non-q-ICG group (n = 37). Baseline characteristics and perioperative outcomes were compared between groups.

RESULTS

Baseline characteristics were generally comparable between groups. All procedures were attempted laparoscopically, one required conversion to open surgery, and no 90-day mortality occurred. No Grade C postoperative pancreatic fistula (POPF) occurred. Compared with the non-q-ICG group, the q-ICG group had shorter operative time (P = 0.025), postoperative hospital stays (P < 0.001), and less intraoperative blood loss (P < 0.001). Bile leakage (2.9 vs. 27.0%; P = 0.007) and Grade B POPF rate (2.9 vs. 24.3%; P = 0.014) were also lower in the q-ICG group. The overall POPF rate was numerically lower in the q-ICG group, but this difference did not reach statistical significance (25.7 vs. 45.9%; P = 0.090).

CONCLUSION

q-ICG-assisted LDPPHR was feasible and was associated with improved perioperative efficiency and selected postoperative outcomes. Given the limited sample size and non-randomized design, prospective studies with standardized protocols are warranted to validate these findings.