Laparoscopic Fenestration of Simple Hepatic Cysts Guided by Indocyanine Green

Abstract

This case report, supplemented by a literature review, highlights indocyanine green (ICG)-guided laparoscopic fenestration as a precise and safe approach for treating symptomatic giant simple hepatic cysts. Although hepatic cysts are usually asymptomatic, their growth can cause pain and require intervention. Laparoscopic fenestration is an effective option, but precision is crucial. We present the case of a 51-year-old female with abdominal pain and hepatomegaly, in whom imaging studies confirmed a giant simple hepatic cyst. Laparoscopic fenestration, using ICG guidance, allowed accurate identification of the cyst and preservation of healthy liver tissue during deroofing, with the extraction of 400 cc of hyaline fluid. Histopathological analysis confirmed the benign nature of the cyst. The patient was discharged 48 hours postoperatively without complications, highlighting the safety and efficacy of the procedure. This case underscores the importance of preoperative planning with accurate imaging studies and highlights how intraoperative guidance with ICG can improve the precision and safety of laparoscopic fenestration, minimizing the risk of complications. ICG-guided laparoscopic fenestration emerges as a valuable alternative in the management of symptomatic giant hepatic cysts, supporting ongoing research on the role of fluorescence in liver surgery to optimize outcomes.