Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: Results of an international Delphi survey

Dip, Fernando; Aleman, Julio; DeBoer, Esther; Boni, Luigi; Bouvet, Michael; Buchs, Nicholas; Carus, Thomas; Diana, Michele; Elli, Enrique F.; Hutteman, Merlijn; Ishizawa, Takeaki; Kokudo, Norihiro; Menzo, Emanuele Lo; Kaja, Ludwig; Régimbeau, Jean Marc; Roy, Mayank; Schneider-Koriath, Sylke; Schols, Rutger M.; Sherwinter, Danny A.; Simpfendorfer, Conrad; Stassen, Laurent; Szomstein, Samuel; Vahrmeijer, Alexander L.; Verbeek, F.P.R.; Walsh, Matthew; White, Kevin P.; Rosenthal, Raúl J.

doi:10.1016/j.surg.2022.07.012

Cited by 9 publications

(6 citation statements)

References 51 publications

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“…In a recent Delphi survey, the consensus was weight-based doses of 0.05 mg/kg as a minimum. Intravenous injection is administered at least 30 min before the surgery ( 34 ). Conversely, direct IB injection does not require pre-administration.…”

Section: Resultsmentioning

confidence: 99%

Utility of indocyanine green fluorescent dye in emergency general surgery: a review of the contemporary literature

Khalaf,

Abdelrahman,

El-Menyar

et al. 2024

Front. Surg.

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For decades, indocyanine green (ICG) has been available for medical and surgical use. The indications for ICG use in surgery have expanded where guided surgery directed by fluorescence and near-infrared fluorescent imaging offers numerous advantages. Recently, surgeons have reported using ICG operative navigation in the emergency setting, with fluorescent cholangiography being the most common procedure. The utility of ICG also involves real-time perfusion assessment, such as ischemic organs and limbs. The rising use of ICG in surgery can be explained by the ICG's rapid technological evolution, accuracy, ease of use, and great potential to guide precision surgical diagnosis and management. The review aims to summarize the current literature on the uses of ICG in emergency general surgery. It provides a comprehensive and practical summary of the use of ICG, including indication, route of administration, and dosages. To simplify the application of ICG, we subdivided its use into anatomical mapping and perfusion assessment. Anatomical mapping includes the biliary tree, ureters, and bowel. Perfusion assessment includes bowel, pancreas, skin and soft tissue, and gonads. This review provides a reference to emergency general surgeons to aid in implementing ICG in the emergency setting for more enhanced and safer patient care.

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Section: Resultsmentioning

confidence: 99%

Utility of indocyanine green fluorescent dye in emergency general surgery: a review of the contemporary literature

Khalaf,

Abdelrahman,

El-Menyar

et al. 2024

Front. Surg.

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“…In addition, a large systematic review including 19 studies concluded that near-infrared imaging with ICG offered equal results, when compared to IOC, regarding biliary tract mapping and thus, could be an efficient non-interventional method of achieving Critical View of Safety[ 11 ]. Despite promising results of ICG fluorescence-guided LC, variability remains in numerous aspects of its use, including optimal dose, route and timing of administration[ 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…Direct intragallblader ICG administration overwhelms the barrier of time needed between administration and imaging[ 18 ]. On the contrary, intragallblader injection requires significantly lower doses compared to intravenous use, approximately 0.025 mg/mL, since the fluorescent dye is confined to the biliary tree[ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Near-infrared cholangiography with intragallbladder indocyanine green injection in minimally invasive cholecystectomy

Symeonidis,

Mantzoros,

Anestiadou

et al. 2024

World J Gastrointest Surg

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Laparoscopic cholecystectomy (LC) remains one of the most commonly performed procedures in adult and paediatric populations. Despite the advances made in intraoperative biliary anatomy recognition, iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems. A series of methods have been proposed to prevent bile duct injury, among them the use of indocyanine green (ICG) fluorescence. The most commonly reported method of ICG injection is the intravenous administration, while literature is lacking studies investigating the direct intragallbladder ICG injection. This narrative mini-review aims to assess the potential applications, usefulness, and limitations of intragallbladder ICG fluorescence in LC. Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy, as well as special issues regarding its use. Literature search retrieved four prospective cohort studies, three case-control studies, and one case report. In the three case-control studies selected, intragallbladder near-infrared cholangiography (NIRC) was compared with standard LC under white light, with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography (IOC). In total, 133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC. Literature includes several reports of intragallbladder ICG administration, but a standardized technique has not been established yet. Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping, overwhelming limitations of IOC including intervention and radiation exposure, as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence. Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.

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“…[33][34][35][36] Two conflicting approaches to the timing of drug injection, one around 15 h before surgery to minimize liver background fluorescence interference, and the other around 45 min before surgery for practical clinical application, have been proposed. 20,37,38 Given that most LC patients undergo surgery upon admission, the 15 h administering timeframe is often impractical. Consequently, our study chose the 45 min presurgery injection of ICG for NIFC, necessitating a strategy to minimize liver background fluorescence.…”

Section: Discussionmentioning

confidence: 99%

“…Despite widespread adoption and evaluation in recent years, variations persist in ICG's clinical utility, including dose, concentration, and administration of timing. A recent Delphi survey 20 recommends injecting ICG at least 45 min preoperatively to reduce liver light intensity. Commonly used intravenous ICG doses are a fixed dose of 2.5 mg or weight‐adjusted 0.05 mg/kg 21 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of different indocyanine green doses in fluorescent laparoscopic cholecystectomy: A prospective, randomized, double‐blind trial

Wang,

Yuan,

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesIntraoperative bile duct injury is a significant complication in laparoscopic cholecystectomy (LC). Near‐infrared fluorescence cholangiography (NIFC) can reduce this complication. Therefore, determining the optimal indocyanine green (ICG) dosage for effective NIFC is crucial. This study aimed to determine the optimal ICG dosage for NIFC.MethodsThis was a prospective, randomized, double‐blind clinical trial at a single tertiary referral center, including 195 patients randomly assigned to three groups: lower dose (0.01 mg/BMI) ICG (n = 63), medium dose (0.02 mg/BMI) ICG (n = 68), and higher dose (0.04 mg/BMI) ICG (n = 64). Surgeon satisfaction and detection rates for seven biliary structures were compared among the three dose groups.ResultsDemographic parameters did not significantly differ among the groups. The medium dose (72.1%) and higher dose ICG groups (70.3%) exhibited superior visualization of the common hepatic duct compared to the lower dose group (41.3%) (p < 0.001). No differences existed between the medium and higher dose groups. Similar trends were observed for the common bile duct and cystic common bile duct junction.ConclusionsIn patients undergoing fluorescent laparoscopic cholecystectomy, the 0.02 mg/BMI dose of indocyanine green demonstrated better biliary structure detection rates than the 0.01 mg/BMI dose and was non‐inferior to the 0.04 mg/BMI dose.

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Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: Results of an international Delphi survey

Cited by 9 publications

References 51 publications

Utility of indocyanine green fluorescent dye in emergency general surgery: a review of the contemporary literature

Utility of indocyanine green fluorescent dye in emergency general surgery: a review of the contemporary literature

Near-infrared cholangiography with intragallbladder indocyanine green injection in minimally invasive cholecystectomy

Efficacy of different indocyanine green doses in fluorescent laparoscopic cholecystectomy: A prospective, randomized, double‐blind trial

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