Intracholecystic administration of indocyanine green for fluorescent cholangiography during laparoscopic cholecystectomy—A two-case report

Jao, Man-Ling; Wang, Yen‐Yu; Wong, Hon Phin; Bachhav, Sayali; Liu, Kai-Che

doi:10.1016/j.ijscr.2020.02.054

Cited by 11 publications

(17 citation statements)

References 19 publications

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“…To reduce the background hepatic noise, the intracholecystic route of administration has also been studied to specifically delineate the extrahepatic biliary structures. 23,24 Although direct intracystic administration might help to increase signal-to-noise ratio, it did not show any effect on total operative time. Recently, 1 randomized clinical trial 25 has been reported where the ICG fluorescence technique has been compared with the intra-operative X-ray cholangiography (IOC).…”

Section: Discussionmentioning

confidence: 98%

Study of Learning Curve in a Surgeon for Near-Infrared Fluorescence Cholangiography During Laparoscopic Cholecystectomy-A Retrospective Evaluation

Tseng

Huang

et al. 2022

Surg Innov

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Background Near-infrared indocyanine green fluorescence cholangiography (NIRF) has shown promising results on delineating extra-hepatic biliary anatomy during laparoscopic cholecystectomy to avoid bile duct injury. However its routine usage remains in question. In this study, the technique was evaluated further with learning curve estimation and learning factors were observed. Methods One hundred ninety-nine cases which underwent laparoscopic cholecystectomy for acute or chronic cholecystitis within a 2-year period including 51 cases with initial use of NIRF by 2 surgeons were studied retrospectively. The learning curve was evaluated for a surgeon as primary objective. A case-matched comparison of the operative time between NIRF and conventional group, in terms of acute and chronic cholecystitis was also conducted as a secondary calculation. Results Learning curve was evaluated with 61% learning rate for NIRF experience. Cysto-biliary junction non-illuminated cases under fluorescent view, had mean operative time of 80.83 ± 22.82 min, which was shorter than the cysto-biliary junction illuminated cases. The NIRF group exhibited longer operative time compared with the conventional group with mean difference of 34.39 min (significant at P < .05). Conclusions While the initial learning phase might be affected by surgeons’ behavior and attitude, our results may provide a reference to learn at one’s own pace and to employ NIRF teaching strategies during surgical training programs to overcome the initial phase during training period itself and facilitate universal achievement.

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Section: Discussionmentioning

confidence: 98%

Study of Learning Curve in a Surgeon for Near-Infrared Fluorescence Cholangiography During Laparoscopic Cholecystectomy-A Retrospective Evaluation

Tseng

Huang

et al. 2022

Surg Innov

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“…A possible explanation of the discrepancy between the identification and the dissection of the extrahepatic biliary structures is that these two elements might not be integrated in the resident studied herein; the resident was able to accurately identify the structures by fluorescence cholangiography but could not skillfully dissect the structures. Another potential explanation is that the operative time is not a reliable parameter to assess the utility of fluorescence cholangiography, as the operative time could be influenced by the inflammation, adhesions, and fibrotic tissue around the gallbladder 12 . Approximately half of the patients in the educational phase had undergone preoperative gallbladder drainage, which might increase the difficulty of surgical procedures for the surgery resident and affect the operative time.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and educational value of fluorescence cholangiography in laparoscopic cholecystectomy

Oiwa¹,

Takahashi²,

Hirano³

et al. 2021

Asian J Endoscop Surgery

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Introduction Near‐infrared fluorescence cholangiography during a laparoscopic cholecystectomy has become widely accepted as a useful auxiliary tool to visualize the extrahepatic biliary structures. We investigated the feasibility and educational value of a method with longer interval between the administration of indocyanine green and the imaging of these structures. Methods Approximately 18 hours before their surgery, patients (n = 51) were intravenously administered 0.25 mg/kg of indocyanine green. Each laparoscopic cholecystectomy was performed under fluorescence imaging in combination with white‐light imaging. Operative outcomes including visualization of the extrahepatic biliary structures and operative time were compared between the patients on whom board‐certified surgeons operated (feasibility phase; n = 18) and the patients on whom a surgery resident operated (educational phase; n = 33). Results There were no adverse events related to the longer interval method. The visualization rates of extrahepatic biliary structures were comparable between the two phases. Both the mean time to divide the cystic duct and the mean time to remove the gallbladder in the educational phase were significantly longer than those in the feasibility phase (68.2 vs 24.4 minutes and 30.2 vs 15.8 minutes, P < .001 each). There was no significant difference in other operative outcomes. The operative time learning curve did not decrease with a resident's experience. Conclusions Fluorescence cholangiography with the longer interval method was feasible and could identify the extrahepatic biliary structures irrespective of the surgeon's experience; however, it did not decrease the operative time with experience.

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“…11, 28 For cholangiography by direct ICG injection to gallbladder, 0.0025 2.5 mg/mL of ICG was administrated. [29][30][31] In this case, 0.25 mg/mL ICG was injected directly via the sinus orifice until the confirmation of back flow. The sinus tract that could not be identified by white color light was immediately identified with clear fluorescent at this concentration.…”

Section: Discussionmentioning

confidence: 99%

“…For sentinel node identification or tumor location, 5 mg/mL ICG was injected locally 11,28 . For cholangiography by direct ICG injection to gallbladder, 0.0025 ~ 2.5 mg/mL of ICG was administrated 29‐31 …”

Section: Discussionmentioning

confidence: 99%

Indocyanine green fluorescence‐guided laparoscopic removal of infected mesh with chronic sinus formation after inguinal mesh plug repair

Shimada

Hirose

Matsubara

et al. 2021

Asian J Endoscop Surgery

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Chronic mesh infection with sinus formation is usually amenable to open method with dye. Recently, intraoperative real-time fluorescent imaging has been applied to various organs but not to mesh infection. A 72-year-old man with the history of two times removal of infected mesh was referred for groin bulge with purulent discharge. Laparoscopy assisted infected mesh removal was undertaken using intraoperative real-time fluorescent imaging with indocyanine green injection via the sinus orifice. We experienced the first case of the infected mesh with chronic sinus formation treated by the help of intraoperative indocyanine green fluorescent. This method is simple and easy to apply for laparoscopic assisted removal of chronic mesh infection with sinus.

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Intracholecystic administration of indocyanine green for fluorescent cholangiography during laparoscopic cholecystectomy—A two-case report

Cited by 11 publications

References 19 publications

Study of Learning Curve in a Surgeon for Near-Infrared Fluorescence Cholangiography During Laparoscopic Cholecystectomy-A Retrospective Evaluation

Study of Learning Curve in a Surgeon for Near-Infrared Fluorescence Cholangiography During Laparoscopic Cholecystectomy-A Retrospective Evaluation

Feasibility and educational value of fluorescence cholangiography in laparoscopic cholecystectomy

Indocyanine green fluorescence‐guided laparoscopic removal of infected mesh with chronic sinus formation after inguinal mesh plug repair

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