Hyper-diluted indocyanine green fluorescence cholangiography: The way to prevent bile leak from the duct of Luschka

The duct of Luschka is the most common anatomical variation of the biliary tree. It is the second most common cause for bile leak in laparoscopic cholecystectomy. Many times, it is not identified until bile leak occurs after the operation. We routinely use hyper-diluted indocyanine green (ICG) with 0.025 mg injection on induction for overlay ICG-fluorescence cholangiography for difficult laparoscopic cholecystectomy. A 78-year-old male underwent an elective laparoscopic cholecystectomy and open left inguinal hernia repair. After resection of the gall bladder, a duct of Luschka with bile leak was identified under ICG-fluorescence cholangiography. Leakage was controlled with metal clips under real-time cholangiography.