Subscribe to RSS
DOI: 10.1055/s-0042-1747913
Co-injection of Bile and Indocyanine Green for Detecting Pancreaticobiliary Maljunction of Choledochal Cyst
Abstract
The usage of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has gained popularity in many procedures in pediatric surgery. ICG generates fluorescent light only when it combines with a protein. We herein report a novel technique for detecting pancreaticobiliary maljunction (PBMJ) with co-injection of bile and ICG in laparoscopic choledochal cyst resection and hepaticojejunostomy for a pediatric patient. A 4-year-old girl presented with abdominal pain and intermittent vomiting. Enhanced computed tomography and magnetic resonance cholangiopancreatography showed a 17-mm type Ia choledochal cyst. Definitive PBMJ was not detected preoperatively. Laparoscopic choledochal cyst resection and hepaticojejunostomy were performed using five ports. A percutaneous silicon catheter was inserted into the gallbladder, and bile juice was aspirated. The amylase level of the bile juice was over 3 × 105 IU/L. The aspirated bile juice and ICG were mixed and co-injected into the gallbladder through the catheter. ICG combined with protein in bile juice and generated fluorescent light. Dilated common bile duct and pancreas were detected by NIR fluorescence imaging. This imaging technique was helpful for detecting the dissection margin of the distal side of the choledochal cyst inside the pancreatic tissue and preventing injury of the pancreatic tissue. This is the first case of ICG application for laparoscopic choledochal cyst resection in a pediatric patient. After resection of the choledochal cyst, laparoscopic hepaticojejunostomy was completely performed. Our technique is a safe and low-invasive method of detecting and excising the distal side of the cyst without a risk of radiography and residual bile duct.
Keywords
indocyanine green - pancreaticobiliary maljunction - choledochal cyst - near-infrared fluorescence imaging - laparoscopic surgeryPublication History
Received: 16 July 2021
Accepted: 02 March 2022
Article published online:
23 August 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Madadi-Sanjani O, Wirth TC, Kuebler JF, Petersen C, Ure BM. Choledochal cyst and malignancy: a plea for lifelong follow-up. Eur J Pediatr Surg 2019; 29 (02) 143-149 DOI: 10.1055/s-0037-1615275.
- 2 Paraboschi I, De Coppi P, Stoyanov D, Anderson J, Giuliani S. Fluorescence imaging in pediatric surgery: state-of-the-art and future perspectives. J Pediatr Surg 2021; 56 (04) 655-662
- 3 Esposito C, Corcione F, Settimi A. et al. Twenty-five year experience with laparoscopic cholecystectomy in the pediatric population-from 10 mm clips to indocyanine green fluorescence technology: long-term results and technical considerations. J Laparoendosc Adv Surg Tech A 2019; 29 (09) 1185-1191 DOI: 10.1089/lap.2019.0254.
- 4 Yoneya S, Saito T, Komatsu Y, Koyama I, Takahashi K, Duvoll-Young J. Binding properties of indocyanine green in human blood. Invest Ophthalmol Vis Sci 1998; 39 (07) 1286-1290
- 5 Ieiri S, Murakami M, Baba T. et al. Technical tips concerning laparoscopic hepaticojejunostomy for choledochal cyst in children with a focus on secure anastomosis for small hepatic ducts. Ann Laparosc Endosc Surg 2019; DOI: 10.21037/ales.2019.02.03.
- 6 Sato T, Onishi S, Shinyama S. et al. Successful laparoscopic dual hepaticojejunostomy of the main hepatic duct and the accessary duct of the right posterior segment to successfully treat a choledochal cyst in a 1-year-old girl: a case report. Videoscopy 2020; 30 DOI: 10.1089/vor.2020.0676.
- 7 Torikai M, Yamada K, Yano K. et al. Secure laparoscopic hepaticojejunostomy of the small hepatic duct for choledochal cyst in children using simple duct plasty and two stay suture techniques. Videoscopy 2020; 30 DOI: 10.1089/vor.2020.0662.
- 8 Machigashira S, Kaji T, Matsui M. et al. Laparoscopic retrograde biliary drainage tube stenting technique of hepaticojejunostomy for preventing anastomotic stenosis of a small hepatic duct: a case of choledochal cyst in a small infant. Videoscopy 2021; 31 DOI: 10.1089/vor.2020.0695.
- 9 Murakami M, Kaji T, Nagano A. et al. Complete laparoscopic choledochal cyst excision and hepaticojejunostomy with laparoscopic Roux-Y reconstruction using a 5-mm stapler: A case of a 2-month-old infant. Asian J Endosc Surg 2021; 14 (04) 824-827 DOI: 10.1111/ases.12928.
- 10 Ko JW, Choi SH, Kwon SW, Ko KH. Robot-assisted hepatectomy and complete excision of the extrahepatic bile duct for type IV-A choledochal cysts. Surg Endosc 2016; 30 (12) 5626-5627 DOI: 10.1007/s00464-016-4923-9.
- 11 Hirayama Y, Iinuma Y, Yokoyama N. et al. Near-infrared fluorescence cholangiography with indocyanine green for biliary atresia. Real-time imaging during the Kasai procedure: a pilot study. Pediatr Surg Int 2015; 31 (12) 1177-1182 DOI: 10.1007/s00383-015-3799-4.
- 12 Ishibashi T, Kasahara K, Yasuda Y, Nagai H, Makino S, Kanazawa K. Malignant change in the biliary tract after excision of choledochal cyst. Br J Surg 1997; 84 (12) 1687-1691
- 13 Ngô C, Sharifzadehgan S, Lecurieux-Lafayette C. et al. Indocyanine green for sentinel lymph node detection in early breast cancer: prospective evaluation of detection rate and toxicity-the FLUOBREAST trial. Breast J 2020; 26 (12) 2357-2363 DOI: 10.1111/tbj.14100.