The Added Value of Intraoperative Near-Infrared Fluorescence Imaging in Elective Laparoscopic Cholecystectomy

Abstract

Bile duct injury is a major complication of laparoscopic cholecystectomy (LC). Intraoperative cholangiogram is useful, but faster techniques are available to assist the surgeon, like near-infrared fluorescent cholangiography (NIFC) with indocyanine green (ICG). The aim of our study is to evaluate the usefulness of NIFC during LC. This is a retrospective study conducted on prospectively recorded data of the General Surgery department of Trieste Academic Hospital, Italy. All patients underwent elective LC from January 2016 to January 2020. Patients were randomly divided in 2 groups: in one group, only white light imaging was used (n = 98 patients), in the NIFC group (n = 63) ICG was used. NIFC has been chosen more frequently by residents than consultants ( P = .002). Operative time and length of stay resulted shorter in ICG group ( P = .002 and .006), and this group showed also fewer intraoperative complications ( P = .007). NIFC does not require any learning curve and makes surgery faster and safer.

Near-infrared indocyanine green fluorescent cholangiography in urgent and emergency laparoscopic cholecystectomy: a preliminary study after propensity score-matched study

“…Given the feasibility of NIFC (preoperative ICG administration and no additional equipment [ 21 ]), we can take full advantage of it, such as shorter operation time [ 8 , 21 ] and the reduction of BDI.…”

“…For elective surgery, but not for acute condition, are reported doses ranged from 0.02 to 0.25 mg/kg [ 8 , 30 , 31 ] and the optimal time and the optimal quantitively of ICG for NIFC still need to be defined.…”

“…Bile duct injury (BDI) is a known complication of LC [ 5 ], with reported rates ranging from 0.4% to 7% in elective cases, and is primarily attributed to intraoperative misidentification of the biliary anatomy [ 6 – 8 ].…”

“…This method utilizes indocyanine green (ICG) as a contrast agent, which is selectively metabolized by hepatic parenchymal cells and secreted entirely into the bile. By excitation of the ICG with a near-infrared laser, real-time assessment of the biliary system can be accomplished [ 8 , 10 ].…”

“…Several studies have reported the safety and efficacy of ICG-assisted LC in elective settings for ACC [ 8 , 11 , 12 ]. However, the role of ICG in the emergency setting of LC remains to be fully explored through further investigation and only one study tries to investigate the role of ICG in the emergency setting of LC [ 13 ].…”