Fluorescent cholangiography: An up-to-date overview twelve years after the first clinical application

Table 1 Cholecysto-cholangiography with direct intra-gallbladder indocyanine green injection

Ref.	Type of publication	No. of patients	No. of patients with gallbladder lithiasis	No. of patients with acute cholecystitis	Technique	Complication	Conversion to open surgery
Jao et al[26], 2020	Case series	2	0	2	2 trans-PTGBD cases	Lymphatic spillage	0
Nitta et al[24], 2020	Case report	1	0	1	1 case through DGBP	-	0
Škrabecet al[23], 2020	Case-controlled study	20	19	1	20 cases through DGBP	ICG bile leakage in 1 case; No progression of dye into the CD in 3 cases	1
Liu et al[22], 2017	Cohort study	46	21	25	18 trans-PTGBD cases; 28 cases through DGBP	ICG leakage in 5 cases	0
Graves et al[25], 2017	Cohort study	11	9	2	11 cases through DGBP	No progression of dye into the CD in 1 case	0

PTGBD: Percutaneous transhepatic gallbladder drainage; DGBP: Direct gallbladder puncture; ICG: Indocyanine green; CD: Cystic duct.

Table 2 Fluorescent cholangiography in patients with acute cholecystitis

Ref.	Type of publication	Procedure	No. of patients
Agnus et al[17], 2020	Euro-FIGS registry	LC	58
Dip et al[32], 2020	RCT	LC	44
Di Maggio et al[30], 2020	Prospective cohort study	LC	16
Daskalaki et al[31], 2014	Retrospective cohort study	RC	24
Yoshiya et al[33], 2019	Retrospective cohort study	LC after-PTGBD	130

FIGS: Fluorescence image-guided surgery; RCT: Randomized controlled trial; LC: Laparoscopic cholecystectomy; RC: Robotic cholecystectomy; PTGBD: Percutaneous transhepatic gallbladder drainage.

Table 3 Recruiting randomized controlled trials using indocyanine green fluorescence cholangiography

Study coordinator; NCT No.	Participating country	No. of patients	Period study	Published data	Main outcome	Controlled group	Dose indocyanine green	Dosing time	Conversion to open surgery	Bile duct injury
Dip et al[32]; NCT 02702843	United States	639	April 2016	Ann Surg 2020	Identification of biliary anatomy	White light	0.05 mg/kg	> 45 min prior to surgery	One patient for bleeding	No
Lehrskov et al[50]; NCT 02344654	Denmark	120	March 2015-August 2018	Br J Surg 2020	Visualization of the critical junction	Intraoperative cholangiogram	0.05 mg/kg	After intubation	No	No
van den Bos et al[61]; NCT 02558556	The Netherlands	308	January 2016	Ongoing	Time to achieve critical view of safety	White light	2.5 mg	After intubation	NA	NA
Koong et al[60] ; NCT04228835	Malaysia	63	March2017-July 2019	Asian J Surg 2021	Time to achieve critical view of safety	White light	2.5 mg	Before induction of anesthesia	No	No

NA: Not available.

Table 4 Advantages and current limitations of fluorescent cholangiography in comparison to intraoperative cholangiogram and laparoscopic ultrasonography

Advantages	Limitations
Real-time visualization of biliary anatomy in elective and emergent settings	Limited in patients with specific conditions, such as overweight and obesity; it needs a preliminary dissection and exposure of the hepatocystic triangle
Safer dissection of the hepatocystic triangle	Limited scientific evidence in the setting of acute cholecystitis
Detection of biliary variants and biliary leaks	High variability about indocyanine green dose and dosing time
Implementing method in combination with adequate dissection and identification technique to achieve critical view of safety	Detection of bile duct stones
Feasibility and safety	Need for consensus conference and international guidelines
Reduced medical costs
Time/faster
Lack of X-ray exposure
Simplicity and lack of learning curve
Teaching tool for young surgeons
Possibility to associate fluorescent angiography
Strong potential to become a gold standard during all cholecystectomies

Table 5 Studies reporting robotic cholecystectomy and near-infrared fluorescent cholangiography

Ref.	Type of publication	No. of patients	Technique	Incidence of conversion rate to open surgery (%)
Sharma et al[72], 2017	Retrospective cohort study	96	RC	2.1
Gangemi et al[73], 2017	Retrospective cohort study	676	RC	0.15
Maker et al[71], 2017	Cohort study	35	RC	NR
Daskalaki et al[31], 2014	Retrospective cohort study	184	RC	0.00
Spinoglio et al[70], 2013	Cohort study	45	SIRC	0.00
Buchs et al[55], 2013	Cohort study	23	SIRC	0.00
Buchs et al[69], 2012	Prospective cohort study	12	SIRC	0.00

RC: Robotic cholecystectomy; SIRC: Single-incision robotic cholecystectomy; NR: Not reported.