Real-time Fluorescence Imaging With Indocyanine Green During Laparoscopic Duodenum?preserving Pancreatic Head Resection

Aim:Laparoscopic duodenum-preserving pancreatic head resection(LDPPHR)is a surgical method used to treat benign and low-grade malignant pancreatic head tumors.However,LDPPHR is prone to complications,such as intraoperative bile duct injury,postoperative bile leakage,and biliary stricture.This study aimed to determine the protective effect of common bile duct in LDPPHR using indocyanine green(ICG)fluorescence imaging.Materials and Methods:A retrospective analysis of 30 patients treated with LDPPHR at the Second Affiliated Hospital of Nanchang University between January 2015 and November2022 was performed.Patients were divided into two groups based on ICG use: ICG and non-ICG.Patient demographic characteristics,surgical methods,surgical results,postoperative conditions,pathological diagnosis,and follow-up data were retrospectiv-ely collected and analyzed.Results:Thirty patients received LDPPHR,11 males and 19 females,and the average age was 51.97 years(19-76 years).LDPPHR was successfully performed in 27(90%)patients,Laparoscopic pancreatoduodenectomy(LPD)was performed in 1(3%)patient,and laparotomy conversion was performed in 2(7%)patients.One patient(3%)died 21 days after surgery.The incidence of intraoperative bile duct injury in the ICG group was lower than that in the non-ICG group(10% vs 50%,p = 0.032),and the operation time in the ICG group was shorter than that in the non-ICG group(311.9 ± 14.97 vs 338.05 ± 18.75 min,p < 0.05).Postoperative pancreatic fistula occurred in 16 patients(53%),including 10 with biochemical leakage(62.5%),four with grade B(25%),and two with grade C(12.5%).Postoperative bile leakage occurred in four patients(13%).Pancreatic exocrine dysfunction occurred in one patient(6%)during follow-up.Conclusions:The ICG fluorescence imaging technology in LDPPHR helps protect the integrity of the common bile duct and reduce the occurrence of intraoperative bile duct injury,postoperative bile leakage,and bile duct stenosis.