Real-Time Full-Color Overlay Indocyanine Green Navigation for Laparoscopic Deroofing of Liver Cysts.

Abstract

Introduction: Laparoscopic deroofing is the standard treatment for symptomatic liver cysts. Indocyanine green (ICG) fluorescence imaging has been effectively used to delineate the boundary between cysts and liver parenchyma; however, intermittent switching between fluorescence and normal light modes is time-consuming and requires memorizing the cutting lines along a curved surface, which can be burdensome during surgery.

Case presentation: We report two cases of laparoscopic deroofing of liver cysts using the PINPOINT and 1788 systems, which enable full-color visualization of ICG signals and real-time surgical navigation. The full-color overlay mode clearly defines the cyst-liver boundary, allowing surgeons to determine optimal resection lines and perform procedures simultaneously. This enhances surgical precision, reduces intraoperative stress, and may improve outcomes. Both patients had uneventful recoveries and were discharged on POD 8.

Conclusions: Laparoscopic deroofing with real-time ICG navigation is a safe and accurate surgical technique, performed in a minimally invasive setting that facilitates efficient and precise liver cyst resection.