In 37 of the 132 patients (19 %), no fluorescence was detected on the cut surface of the remnant liver on ICG fluorescent cholangiography, suggesting absence of bile ducts at the surgical margin (Type A pattern of fluorescence). In the remaining 95 patients, the pattern of fluorescence was classified into the following three types: intact bile duct type (Type B, fluorescence showed one or more intact bile ducts on the cut surface of the liver; n = 51) (Fig. 18.4), injured bile duct type (Type C, leakage of dye from one or more bile duct stumps on the cut surface; n = 31) (Fig. 18.5), and unconfirmed type (Type D, leakage of dye from the cut surface, but the source was unclear; n = 13) (Fig. 18.6 and Video 18.2). In Type D pattern, the minor dye leaks could not be visualized by the surgeon, and could only be detected by viewing the fluorescent images on the monitor.

No repair was performed in patients with Type A pattern of fluorescence. In patients with Type B pattern, repair was performed by z-suturing with 6-0 non-absorbable sutures in 42 patients (1.5 ± 0.8 (mean ± SD) sutures per patient) and by ligation with 4-0 absorbable sutures in the remaining nine patients (1.0 ± 0.2 ligatures per patient). In the three patients with Type D pattern, fibrin sealant was applied to the area showing leakage (two pieces of 2.0 × 1.5 cm sealant per patient). The fluorescence imaging findings were used to guide treatment in the patients with Type D pattern.

Postoperative bile leakage occurred in 7 of the 132 hepatectomy patients (5 %) and persisted for a median period of 6 weeks (range, 2–15 weeks). Table 18.1 shows the incidence of each pattern of fluorescence. The rate of Type D pattern differed from the rates of the other three patterns.