Abstract
BackgroundPrimary intrahepatic bile duct dilatation can be very harmful to patients although it belongs to benign biliary disease. It can occur in any part of the liver, intraoperative laparoscopic ultrasound (LUS) guidance combine with real-time indocyanine green (ICG) fluorescence navigation are the means of choice for accurate surgical resection.Case presentationHerein we reported a 43-year-old female patient presented with repeated right upper abdominal pain and distension for 3 years and aggravated for half a year, without fever and jaundice. A diagnosis of localized bile duct dilatation with lithiasis in segment 4 (S4) was made on the basis of preoperative imaging. Correspondingly, we selected to perform a laparoscopic surgery with LUS guided real time ICG fluorescence imaging (ICG-FI) and navigation to make the operation more simply and accurately, as well as to retain normal tissues in a certain extent. Laparoscopic resection of S4b and partial S4a was successfully performed, without any complications.ConclusionLaparoscopic anatomical surgery for intrahepatic bile duct dilatation is a technically challenging operation. The combined use of preoperative three-dimensional computerized tomography (CT) planning, intraoperative LUS guided super-selection, ICG hepatic segment staining and real-time fluorescence navigation could help surgeons accurately complete the segmentectomy or subsegmentectomy with minimized trauma and maximized liver tissue preservation.
Highlights
Primary intrahepatic bile duct dilatation can be very harmful to patients it belongs to benign biliary disease
Primary intrahepatic bile duct dilatation is a common biliary tract disease in China, and its clinical manifestations are mainly related to the onset of cholangitis, stone formation, liver abscess and so on
indocyanine green (ICG)-FI has shown its unique value in anatomical laparoscopic hepatectomy (LH) for hepatic malignancies, but it is rarely used in the treatment of the intrahepatic bile duct dilatation or hepatolithiasis, which is worthy of further exploration and application
Summary
Primary intrahepatic bile duct dilatation can be very harmful to patients it belongs to benign biliary disease. It can occur in any part of the liver, intraoperative laparoscopic ultrasound (LUS) guidance com‐ bine with real-time indocyanine green (ICG) fluorescence navigation are the means of choice for accurate surgical resection. The ICG fluorescence imaging (ICG-FI) technique might be able to clearly identify hepatic segmental boundaries and the location of tumors, helping operators to timely adjust the surgical approach and accurately dissect the hepatic segments, avoid tumor residue and reduce vessel damage. We report a case of localized S4 intrahepatic bile duct dilatation treated successfully with accurate surgical resection by laparoscopic ultrasoundguided superselective portal vein injection combined with real-time ICG-FI and navigation
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