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

## TL;DR

This paper introduces a new real-time imaging technique using indocyanine green to improve precision during laparoscopic surgery for liver cysts.

## Contribution

The study presents a novel real-time full-color ICG navigation system for laparoscopic deroofing of liver cysts.

## Key findings

- Real-time full-color ICG overlay improves visualization of cyst-liver boundaries during surgery.
- The technique reduces intraoperative stress and allows simultaneous navigation and resection.
- Two patients had successful outcomes with uneventful recoveries after the procedure.

## Abstract

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.

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.

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.