Surg Endosc. 2026 Aug 3. doi: 10.1007/s00464-026-13194-6. Online ahead of print.
ABSTRACT
BACKGROUND: Laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) is technically demanding. We developed a quantitative indocyanine green fluorescence imaging protocol (q-ICG) to assist LDPPHR and evaluated its clinical utility.
METHODS: We retrospectively analyzed 72 patients who underwent LDPPHR between 2019 and 2025. Patients were divided into a q-ICG group (n = 35) and a non-q-ICG group (n = 37). Baseline characteristics and perioperative outcomes were compared between groups.
RESULTS: Baseline characteristics were generally comparable between groups. All procedures were attempted laparoscopically, one required conversion to open surgery, and no 90-day mortality occurred. No Grade C postoperative pancreatic fistula (POPF) occurred. Compared with the non-q-ICG group, the q-ICG group had shorter operative time (P = 0.025), postoperative hospital stays (P < 0.001), and less intraoperative blood loss (P < 0.001). Bile leakage (2.9 vs. 27.0%; P = 0.007) and Grade B POPF rate (2.9 vs. 24.3%; P = 0.014) were also lower in the q-ICG group. The overall POPF rate was numerically lower in the q-ICG group, but this difference did not reach statistical significance (25.7 vs. 45.9%; P = 0.090).
CONCLUSION: q-ICG-assisted LDPPHR was feasible and was associated with improved perioperative efficiency and selected postoperative outcomes. Given the limited sample size and non-randomized design, prospective studies with standardized protocols are warranted to validate these findings.
PMID:42547636 | DOI:10.1007/s00464-026-13194-6
