The application of intraoperative vascular and biliary tract imaging in laparoscopic duodenum-preserving pancreatic head resection

Abstract

Objective To investigate the value of applying intraoperative indocyanine green fluorescence imaging in laparoscopic duodenum-preserving pancreatic head resection. Methods The clinical data of 12 patients with benign pancreatic head tumors who underwent fluorescence laparoscopic duodenum-preserving pancreatic head resection (FLDPPHR) at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Wannan Medical College, from June 2021 to October 2023 were retrospectively analyzed. All patients received an intravenous injection of indocyanine green (2.5 mg/ml, 1.5 ml) for biliary tract imaging half an hour before surgery. Indocyanine green (2.5 mg/ml, 1 ml) was intravenously injected into the peripheral vein when blood vessels needed to be exposed during the operation. Results FLDPPHR was successfully performed in all 12 patients without conversion to open surgery. The tumor diameter was 3.6±0.1 cm, the operation time was 366.7±24.2 minutes, and the intraoperative blood loss volume was 270.8±25.7 ml. The median number of intraoperative vascular visualizations was 3 (2-4). Postoperative pathological diagnosis revealed intraductal papillary mucinous neoplasm (IPMN) in 6 patients, serous cystadenoma (SCN) in 4 patients, and mucinous cystadenoma (MCN) in 2 patients. The median postoperative hospital stay was 10 (7-40) days. No long-term complications occurred during the follow-up of more than 7 months. Conclusion Real-time exposure of the common bile duct during indocyanine green fluorescence imaging is helpful for reducing damage to the common bile duct, visualizing vessels in the