Biliary atresia (BA) is a serious congenital disorder that can affect both intrahepatic and extrahepatic bile ducts with an incidence of approximately 1:5000–1:19,000 [1]. If not treated timely, liver fibrosis can develop rapidly and the child may need to receive a liver transplant. Depending on the location of the obstruction, there are three types of BA: Type I has obstruction at the level of the common bile duct (CBD) ; Type II is the least common (2.5 %), with obstruction occurring in the common hepatic duct (CHD) ; Type III occurs most frequently (85 %), with the obstruction occurring at the level of the porta hepatis [2]. Cystic biliary atresia (CBA) is a specific type of BA, defined as any type of BA combined with extrahepatic bile duct cysts and accounts for 5–20 % of all BA children [3], [4], [5]. The standard option for the treatment of BA is the Kasai procedure, which is originally performed by open surgery. With the widespread of laparoscopic techniques, an increasing number of surgeons are using laparoscopic techniques to perform BA surgery [6].

The key to BA surgery is the complete removal of atretic tissue to ensure bile drainage. Indocyanine green (ICG) is a relatively nontoxic, fluorescent iodide dye [7]. After intravenous injection, ICG is primarily bound to albumin and this complex can be excited by specific wavelengths of light in the near infrared (NIR) spectrum (approximately 830 nm) to produce fluorescence [8], [9]. As it is almost exclusively absorbed from plasma by hepatic parenchymal cells and completely secreted into the bile, ICG can be used to visualize the anatomy of the hepatobiliary system [9]. In recent years, it has been used in pediatric surgery as a real-time navigation tool to monitor bile flow during Kasai procedures [10].

We report a case of successful application of ICG fluorescence assistance during laparoscopy in a child with rare type II CBA.