Fluorescence-guided lymphadenectomy using intralesional indocyanine green during laparoscopic distal pancreatectomy for pancreatic neuroendocrine tumor.

Near-infrared (NIR) fluorescence with indocyanine green (ICG) is increasingly used in hepatopancreatobiliary surgery, but its value for lymph node identification during pancreatic lymphadenectomy remains uncertain. We describe intralesional ICG injection to aid lymph node detection during laparoscopic distal pancreatectomy for pancreatic neuroendocrine tumor. After pancreatic exposure, 1 mL of ICG (8 mg/mL) was injected intralesionally. NIR imaging delineated peripancreatic lymphatic drainage and highlighted fluorescent lymph nodes, serving as a real-time adjunct during anatomical lymphadenectomy (stations 11p, 8a, 15 and peripancreatic nodal tissue). The postoperative course was uneventful; final pathology showed advanced nodal disease (pN2). This technical note summarizes key operative steps and practical considerations; in this single case, fluorescence served as a real-time adjunct to anatomical lymphadenectomy, while its quantitative impact on nodal yield remains to be defined prospectively.