Case Report: Indocyanine green fluorescence imaging in complex focal nodular hyperplasia resection: report of two...

This report describes indocyanine green (ICG) fluorescence guidance combined with intraoperative ultrasonography (IOUS) for laparoscopic parenchyma-sparing excision of selected perivascular focal nodular hyperplasia (FNH). In two patients with segment IV lesions abutting the portal vein, preoperative ICG administration (0.5 mg/kg, 24 h prior) enabled real-time intraoperative fluorescence imaging integrated with ultrasonography. The dual-modality navigation provided clear visual contrast, facilitating precise lesion delineation and margin assessment. Both patients underwent successful wedge excision with negative surgical margins, with estimated blood loss of 50-20 mL, respectively. Incidental punctate hyperfluorescent foci were observed on the liver surface; one excised focus showed benign hyperplastic changes on histology, while the clinical significance of the remaining foci remains uncertain. These cases suggest that ICG fluorescence may assist laparoscopic parenchyma-sparing excision of selected perivascular FNH lesions, though further studies are needed to define its reproducibility, limitations, and clinical value.