Intra-operative visualization of the common bile duct by ICG fluorescence imaging during a near-total pancreatectomy in an infant

Abstract

Purpose: Drug-resistant diffuse congenital hyperinsulinism in infants is treated with a near-total pancreatectomy. However, dissection of the intra-pancreatic segment of the common bile duct (CBD) is technically challenging, especially with a laparoscopic approach in the very young. Method: We performed a laparoscopic near-total pancreatectomy in a 10 month old child with congentinal hyperinsulinism, and used intra-operative intravenous administration of 0,5 mg / kg indocyanine green (ICG) to visualize the CBD while dissecting pancreatic tissue. Results: Direct vision of the CBD by ICG fluorescence imaging resulted in a succesfull laparoscopic near-total pancreatectomy in this patient, with an adequate amount (95% - 98%) of pancreatic tissue dissected without causing any iatrogenic injury. The postoperative course was uncomplicated, the pharmaceutcical therapy was stopped, and the carbohydrate diet was normalized over time without resulting in hypoglycemic episodes. Conclusion: Intra-operative use of ICG fluorescence imaging could guide surgeons while performing a laparoscopic near-total pancreatectomy in infants with congenital hyperinsulinism to safely dissect the intra-pancreatic segment of the CBD.