PMC9398574_01
Computed tomography (
A
) and magnetic resonance cholangiopancreatography (
B
) show a 17-mm type Ia choledochal cyst according to the Todani classification.
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Enhanced computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed a 17-mm type Ia choledochal cyst according to the Todani classification ( Fig. 1A , 1B ).
(
A
) A mix of bile juice and ICG is co-injected into the gallbladder through a catheter. (
B
) Detection of the distal side of the cyst inside the pancreatic tissue to prevent injury of the pancreatic duct and tissue. (
C
) Application of metal clips just above the junction based on the findings of ICG imaging and cholangiography. (
D
) Confirmation of PBMJ (inside yellow circle) by intraoperative cholangiography using iodine contrast agent. (
E
) Approximation of both the posterior and anterior walls using interrupted intracorporal knot-tying with 5-0 absorbable sutures.
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Tokyo, Japan) were mixed with the same concentration of ex vivo experiment and co-injected into the gallbladder through the catheter ( Fig. 2A ). The dilated common bile duct and pancreas were detected by NIR fluorescence imaging using a near-infrared/ICG camera (KARL STORZ). This imaging technique was useful for detecting the dissection margin of the distal side of the choledochal cyst inside the pancreatic tissue and preventing injury of the pancreatic tissue ( Fig. 2B ). The distal side of the choledochal cyst was transected safely just above the junction based on the findings of ICG imaging and cholangiography ( Fig. 2C , 2D ). Both the posterior and anterior walls were approximated using interrupted intracorporeal knot-tying with 5-0 absorbable sutures ( Fig. 2E ).