Constitutional indocyanine green (ICG) excretion defect (CIED) is a rare clinical condition characterized by markedly delayed ICG disappearance with other normal liver function tests. Here, we report a case of CIED in which laparoscopic anatomical liver resection was successfully performed using ICG fluorescence staining. A 64-year-old man with a 4-cm tumor located in the liver segment 5 was referred to our hospital. His ICG retention rate at 15 min was 70%, but other liver function tests including Tc-galactosyl human serum albumin scintigraphy were normal. We then planned laparoscopic segmentectomy under the diagnosis of hepatocellular carcinoma and suspected CIED. Laparoscopic hepatectomy was started after confirming a histologically normal liver. After clamping the Glissonean pedicle of segment 5, ICG was injected and the demarcation line was identified. Liver dissection was performed along the demarcation line and the operation was completed. The patient was discharged on postoperative day 10 without any complications.
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