Indocyanine green administration a day before surgery may increase bile duct detectability on fluorescence cholangiography during laparoscopic cholecystectomy

Abstract

Background: The optimal indocyanine green (ICG) administration protocol for fluorescence cholangiography during laparoscopic cholecystectomy (LC) has yet to be determined. Methods: A prospective study including 20 cases of ICG fluorescence-navigated LC was conducted. Accordingly, the first 10 patients were administered 2.5 mg of ICG on the day of surgery after intubation (surgery-day group), while the remaining 10 consecutive patients were administered 0.25 mg/kg of ICG on the evening before surgery (one-day-before group). Fluorescence intensity (FI) of each tissue and FI ratios were then compared between both groups. Results: The median interval between observation and ICG administration was 27 minutes and 16 hours 24 minutes in the surgery-day and one-day-before group, respectively. Although FI values for the common bile duct (CBD), liver, and hepatoduodenal ligament (HDL) were significantly lower in the one-day-before group than in the surgery-day group, CBD-Liver contrast (0.7, 0.6-1.2 vs 2.5, 0.9 =-4.8; P < .001), and CBD-HDL contrast (1.7, 1.4-2.4 vs 2.3, 1.5-13.3; P = .038) were significantly higher in the one-day-before group than in the surgery-day group. Conclusion: ICG administration a day before LC may offer better CBD background contrast compared to administration just prior to surgery.

Systematic review of the role of indocyanine green near‑infrared fluorescence in safe laparoscopic cholecystectomy (Review)

“…The ensuing comments are based on the analysis of 19 studies (6,10-27) documenting the use of ICG NIRC in LCs or RCs, for non-malignant gallbladder disease (symptomatic biliary lithiasis, acute or chronic cholecystitis, and gallbladder polyps) in a total of 2,490 patients. Only 2are randomized controlled studies (RCT), 11 prospective and 6 are retrospective studies (7,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) (Table I). The safety of the ICG was excellent, there was only one report of a self-resolved rash (0.04%), with no other adverse reactions.…”

“…In most of the cases, ICG was administered shortly before or at the induction of anesthesia, with a time range of 30-60 min to the intervention. The doses in these cases were either a fixed dose varying between 1.25-7.5 mg of diluted ICG solution (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)27), or an adjusted dose of 0.02-0.62 mg/kg (11,12,28). The majority of the studies included in the review used 2.5 mg administered within 1 h before imaging (7,14-23).…”

Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA™ technology: preliminary experience in two pediatric surgery centers

“…Another debated point is the optimal dosage and timing of administration of ICG to obtain optimal visualization of the extrahepatic biliary tree [ 24 , 25 ]. We adopted a dosage of 0.35 mg/kg in all cases, and the median time of administration was 15.6 h prior to surgery.…”

Indocyanine green fluorescence navigation for hepatocellular carcinoma with bile duct tumor thrombus: a case report

“…For fluorescence cholangiography, original method was 2.5 mg before surgery [16]. In this regard, studies discuss that earlier timing may offer clear contrast between bile duct and background [21,22]. To weaken the fluorescence of bile for the contrast between BDTT and bile, we consider small amount of ICG (2.5 mg) one day before surgery is reasonable.…”