Systematic Review Protocol. Near Infra-Red Indocyanine Green Fluorescent Cholangiography Versus Intraoperative Cholangiography to Improve Safety in Laparoscopic Cholecystectomy for Gallstone Disease – A Systematic Review Protocol.

Abstract

BackgroundLaparoscopic cholecystectomy has become the standard surgical approach in the treatment of cholelithiasis. The rate of bile duct injury increased significantly during the initial period of its implementation. Diverse surgical techniques and different imaging modalities have been described to provide enhanced views of the biliary anatomy and potentially prevent or early detect bile duct injuries. Both x-ray intraoperative cholangiography (IOC) and Near infra-red indocyanine green fluorescent cholangiography (NIR-ICG) have been described as safe and feasible techniques to assess biliary anatomy. The aim of this systematic review is to evaluate if NIR-ICG can visualise extrahepatic biliary anatomy more efficiently and safer than IOC in minimally invasive cholecystectomy for gallstone disease.MethodsLiterature search will be performed via Medline (PubMed), Embase, Scopus, the Cochrane Central Register of Controlled Trials and web of science. All randomised controlled clinical trials and prospective non-randomised controlled trials which report on comparison of NIR-ICG versus IOC will be included. All patients over 18 years old who require elective or urgent minimally invasive cholecystectomy (undergoing NIR-ICG during this procedure) due to gallstone disease both acute and chronic will be included. Primary outcomes will be ability to visualise extrahepatic biliary anatomy and time to obtain relevant images of the biliary tree.DiscussionOur research expects to give the reader a clear sense of the needed focus of future research and remaining uncertainties in the field. Understanding the benefits of this technique is critical to ensuring policymakers can make informed decisions as to where preventive efforts should be focused regarding specific imaging techniques. If ICG is proven to be faster and non-invasive, routine use could be encouraged and wide implementation could be a reality. Systematic review registrationIn accordance with the guidelines, our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42020177991.