Indocyanine Green Near-Infrared Fluorescence Cholangiogram During Pure Laparoscopic Living Donor hepatectomy For Optimal Bile Duct Division

Abstract

Introduction: Biliary complications in living donor liver transplantation are most common and troubled problem to liver transplant surgeons, various method to decease biliary complications has been studied and determining the optimal bile duct division point is important to decrease complication rate. Intraoperative cholangiogram has been standard method to determine the optimal bile duct division point for conventional donor hepatectomy, but in laparoscopic donor hepatectomy, indocyanine green(ICG) near-infrared fluorescence cholangiogram is alternative option of intraoperative cholangiogram. We compared conventional cholangiogram and ICG near-infrared fluorescence cholangiogram to determine optimal bile duct division point in pure laparoscopic living donor hepatectomy. Method: From May 2016 to October 2019, 80 cases of pure laparoscopic donor hepatectomy has been performed in Kyungpook national university hospital. Conventional cholangiogram was used in 45 cases, ICG near-infrared fluorescence cholangiogram was used in 35 cases. We compared two groups in preoperative bile duct anomaly of donor, operative time and postoperative complications. Result: In bile duct anomaly of donors, there were no differences between two groups. Operative time was much longer in conventional cholangiogram group because conventional cholangiogram procedure itself was time consuming. In one donor of conventional group, biliary complication occurred. Bile leakage from the cutting edge of the remnant right hepatic duct was identified, resolved by ERBD insertion. Conclusion: ICG near-infrared fluorescence cholangiogram is more easier and convenient method to determine proper bile duct division point and is helpful to decrease biliary complications by confirming the real time fluorescence image of bile duct.