# Laparoscopic Cholecystectomy Using Indocyanine Green Fluorescence Imaging in a Patient with a Type I Accessory Hepatic Duct (Hisatsugu Classification): A Case Report

## TL;DR

This case report describes the successful use of indocyanine green fluorescence imaging during laparoscopic cholecystectomy in a patient with a rare biliary anatomy variation.

## Contribution

This is the first reported use of ICG fluorescence imaging for a Type I accessory hepatic duct during laparoscopic cholecystectomy.

## Key findings

- ICG fluorescence imaging enabled clear visualization of biliary anatomy including the accessory hepatic duct.
- The procedure was completed without bile duct injury or complications.
- Post-resection imaging confirmed the integrity of the accessory hepatic duct.

## Abstract

Bile duct injury is a rare but serious complication of laparoscopic cholecystectomy (LC), particularly in patients with biliary anomalies such as accessory hepatic ducts (AHDs). Indocyanine green (ICG) fluorescence imaging has recently been recognized as a valuable tool for intraoperative visualization of biliary anatomy. However, its application in Type I AHDs, as classified by Hisatsugu, has not been previously reported.

A 35-year-old male was referred for elective LC following successful conservative treatment for mild acute cholecystitis. Preoperative magnetic resonance cholangiopancreatography revealed that the cystic duct drained into a posterior AHD arising from segment 6, consistent with a Type I anomaly according to the Hisatsugu classification. At anesthesia induction, 2.5 mg of ICG was administered intravenously, and near-infrared fluorescence imaging enabled clear identification of the biliary anatomy, including the AHD. Despite mild chronic inflammation, Calot’s triangle was safely dissected, and the gallbladder was successfully removed. Post-resection ICG imaging confirmed the integrity of the AHD, with no evidence of injury or stricture. The operative time was 3 h and 30 min, and the patient was discharged without complications on POD 3.

Intraoperative ICG fluorescence imaging allowed for safe and accurate identification of biliary anatomy in a patient with a Type I AHD anomaly. This technique may help reduce the risk of bile duct injury during LC in patients with complex biliary variations.