Laparoscopic Fenestration for a Hepatic Cyst Guided by Preoperative 3D Simulation: A Challenging Case for Fenestration Site Selection

Fenestration is the standard treatment for hepatic cysts, but recurrence remains a concern. We report the case of a 73-year-old woman who presented with leg edema. Computed tomography revealed a 140-mm hepatic cyst extending from segments 8 to 1, compressing the inferior vena cava (IVC). Preoperative 3D simulation using artificial intelligence-assisted imaging software (SYNAPSE VINCENT) demonstrated that the exposed area of the cyst wall not covered by liver parenchyma was limited to the space part of the caudate lobe behind the hepatoduodenal ligament. Laparoscopic fenestration was performed with intraoperative indocyanine green (ICG) guidance to avoid injury to the liver and biliary tract while maximizing the fenestration area. The patient experienced no postoperative complications, and no symptomatic recurrence was observed during 6 months of follow-up. This case highlights the utility of preoperative 3D simulation for fenestration site selection in a challenging hepatic cyst.