New technical development for pure laparoscopic donor hepatectomy: indocyanine green cholangiography and three-dimensional laparoscopy

In addition to the accumulation of experience, improvements in laparoscopic imaging systems, devices, and introduction of new techniques have been reported to overcome limitations in pure laparoscopic donor surgery. Major limitations of conventional laparoscopy are the lack of depth perception and tactile feedback. As a possible solution for the limitations, the successful application of three-dimensional (3D) visualization has been reported; 3D laparoscopy can provide depth perception and also excellent hand-eye coordination. Optimal intraoperative visualization of the biliary duct anatomy and an appropriate cutting point were considered major issues during pure laparoscopic donor hepatectomy. Recently, real-time intraoperative imaging using indocyanine green (ICG) has been reported as a reliable method that may replace conventional intraoperative cholangiography in pure laparoscopic donor hepatectomy. In this review, we describe the current status of ICG cholangiography and 3D laparoscopy in laparoscopic donor hepatectomy.