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López-Sánchez J, Garrosa-Muñoz S, Pardo-Aranda F, Zarate A, López-Pérez R, Rodríguez-Fortúnez P, Sánchez-Santos JM, Esteban C, Quiñones J, Iglesias M, González L, Trébol J, Sánchez-Casado A, García-Plaza A, González-Muñoz JI, Abdel-Lah O, Genè C, Cremades M, Espín F, Navinés J, Vidal L, Piqueras A, Senti S, Herrero C, Cugat E, Muñoz-Bellvís L, Blanco-Antona F. DOse and administration Time of Indocyanine Green in near-infrared fluorescence cholangiography during laparoscopic cholecystectomy (DOTIG): a randomized clinical trial. Surg Endosc 2025; 39:1778-1792. [PMID: 39820601 DOI: 10.1007/s00464-024-11481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 12/08/2024] [Indexed: 01/19/2025]
Abstract
BACKGROUND Different techniques have been proposed to reduce the incidence of the intraoperative bile duct injury during laparoscopic cholecystectomy (LC). Among these, Near-Infrared Fluorescence Cholangiography (NIFC) with Indocyanine Green (ICG) represents a relatively recent addition. At present, there is considerable variation in the protocols for the administration of ICG. METHODS The aim of this randomized multicenter clinical trial (RCT) is to ascertain whether there are differences between the dosage and administration intervals of ICG, with a view to optimizing a good-quality NIFC during LC. Furthermore, an analysis was conducted to determine the potential impact of different factors on the outcomes of this technique. The trial was approved by the local institutional Ethics Committee. RESULTS From June 2022 to June 2023, 200 patients were randomized in four arms (G1: 2.5 mg ICG > 3 h prior to surgery, G2: 2.5 mg ICG 15-30 min prior to surgery, G3: 0.05 mg/kg ICG > 3 h prior to surgery and G4: 0.05 mg/kg ICG 15-30 min prior to surgery). We found differences in the DISTURBED score between the groups (p < 0.001), suggesting that ICG administration 15-30 min before surgery was worse than administration > 3 h after LC (p = 0.02). Additionally, it was observed that body mass index (BMI), gender, ASA Classification System, previous liver and biliary disease and the type of surgery had influence on NIFC. Finally, the NIFC had an impact in intraoperative and postoperative complications, operative time and hospital length of stay. CONCLUSIONS The administration of ICG > 3 h improve liver background fluorescence in the NIFC during LC. There are different factors may affect NIFC results (BMI, ASA grade, previous liver disease, presence of gallbladder inflammation and type of surgery). Finally, high-quality NIFC was associated with fewer surgical complications, shorter surgical time and shorter length of hospital stay.
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Affiliation(s)
- Jaime López-Sánchez
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain.
- Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain.
| | - Sonsoles Garrosa-Muñoz
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
| | - Fernando Pardo-Aranda
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Alba Zarate
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Ricardo López-Pérez
- UICEC-Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | | | | | - Carmen Esteban
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - José Quiñones
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Manuel Iglesias
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Luis González
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
| | - Jacobo Trébol
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Ana Sánchez-Casado
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Asunción García-Plaza
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
| | - Juan Ignacio González-Muñoz
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
| | - Omar Abdel-Lah
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Clara Genè
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Manel Cremades
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Francisco Espín
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Jordi Navinés
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Laura Vidal
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Ana Piqueras
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Sara Senti
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Christian Herrero
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Esteban Cugat
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Luis Muñoz-Bellvís
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
| | - Francisco Blanco-Antona
- Department of General and Gastrointestinal Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española, 37007, Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
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Pavulans J, Jain N, Zeiza K, Sondore E, Cerpakovska KB, Opincans J, Atstupens K, Plaudis H. Fluorescence Cholangiography for Extrahepatic Bile Duct Visualization in Urgent Mild and Moderate Acute Cholecystitis Patients Undergoing Laparoscopic Cholecystectomy: A Prospective Pilot Study. J Clin Med 2025; 14:541. [PMID: 39860547 PMCID: PMC11765729 DOI: 10.3390/jcm14020541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 01/13/2025] [Accepted: 01/14/2025] [Indexed: 01/27/2025] Open
Abstract
Background: Laparoscopic cholecystectomy for acute cholecystitis carries an increased risk of biliovascular injuries. Fluorescence cholangiography (FC) is a valuable diagnostic tool for identifying extrahepatic bile ducts (EHBD). The objective of this study was to evaluate the efficacy of FC in delineating EHBD anatomy, both before and after dissection, based on the critical view of safety (CVS) principles. Methods: Urgently admitted patients were prospectively stratified into two groups, depending on whether they had mild or moderate acute cholecystitis, in accordance with the 2018 Tokyo guidelines. All patients were scheduled for an early laparoscopic cholecystectomy using FC and were administered a fixed dose of indocyanine green (ICG) intravenously 12 h prior to the surgical procedure. Results: A total of 108 patients-75 patients with mild acute cholecystitis and 33 patients with moderate acute cholecystitis-were included. More than four CVS steps were performed in 101 patients (93.5%). Less than four CVS steps were performed only in seven patients-three (2.5%) patients with mild acute cholecystitis and four (4%) patients with moderate acute cholecystitis. The achievement of the CVS principles and the visualization rate using FC significantly increased in both patient groups, ranging from 3% before CVS to 100% after CVS (p < 0.001). In both groups, the cystic duct was visualized in most patients after CVS and FC, followed by the common bile duct and the common hepatic duct. Conversely, even after using CVS and FC, the visualization of the confluence of the cystic and common hepatic ducts remained less likely and challenging in both groups (57.3% in mild patients vs. 33.3% in moderate patients; p = 0.022). Background liver fluorescence disturbance was observed equally in both patient groups (6-11%), but it did not reach statistical significance. The median operative time was 60 ± 25 min in patients with mild acute cholecystitis compared to 85 ± 37 min in patients suffering from moderate acute cholecystitis (p < 0.001). No postoperative complications or biliovascular injuries were observed. Conclusions: FC is a convenient, safe, and efficacious procedure for attaining CVS principles and identifying the EHBD anatomy in most patients. The procedure showed superior results in mild acute cholecystitis patients in comparison to moderate acute cholecystitis patients.
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Affiliation(s)
- Janis Pavulans
- Department of Surgery, Riga Stradinš University, 16 Dzirciema Street, LV-1007 Riga, Latvia; (K.Z.); (J.O.); (H.P.)
- Department of Doctoral Studies, Riga Stradinš University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Department of General Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.S.); (K.B.C.); (K.A.)
| | - Nityanand Jain
- Statistics Unit, Riga Stradinš University, 16 Dzirciema Street, LV-1007 Riga, Latvia;
| | - Kaspars Zeiza
- Department of Surgery, Riga Stradinš University, 16 Dzirciema Street, LV-1007 Riga, Latvia; (K.Z.); (J.O.); (H.P.)
- Department of General Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.S.); (K.B.C.); (K.A.)
| | - Elza Sondore
- Department of General Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.S.); (K.B.C.); (K.A.)
| | - Krista Brigita Cerpakovska
- Department of General Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.S.); (K.B.C.); (K.A.)
| | - Janis Opincans
- Department of Surgery, Riga Stradinš University, 16 Dzirciema Street, LV-1007 Riga, Latvia; (K.Z.); (J.O.); (H.P.)
- Department of General Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.S.); (K.B.C.); (K.A.)
| | - Kristaps Atstupens
- Department of General Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.S.); (K.B.C.); (K.A.)
| | - Haralds Plaudis
- Department of Surgery, Riga Stradinš University, 16 Dzirciema Street, LV-1007 Riga, Latvia; (K.Z.); (J.O.); (H.P.)
- Department of General Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.S.); (K.B.C.); (K.A.)
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Kinami S, Maruyama K, Sannomiya Y, Saito H, Takamura H. Benefits, problems, and optimal timing of administration of indocyanine green fluorescence cholangiography in laparoscopic cholecystectomy. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2025; 7:e000310. [PMID: 39850740 PMCID: PMC11751898 DOI: 10.1136/bmjsit-2024-000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 12/17/2024] [Indexed: 01/25/2025] Open
Abstract
Objectives The advantages of indocyanine green (ICG) fluorescence cholangiography have been emphasized, but its disadvantages remain unclear. This study investigated the advantages and disadvantages of this modality, particularly the optimal timing of administration of ICG fluorescence. Design This was a retrospective analysis of prospectively collected patient data. Setting Data were gathered from a single institution. Participants 69 patients scheduled for cholecystectomy were included. Interventions We administered intravenous ICG injections at three different times: preoperatively (5 mg/body weight (BW), 15 min before incision), morning of the surgery (12.5 mg/BW 4 hours before surgery), and on the day before the surgery (25 mg/BW, 20 hours before surgery). The PINPOINT or SPY-PHI (Stryker) systems were used for fluorescence imaging. Main outcome measures The course of the common bile and cystic ducts was identified using fluorescence imaging. The visualization quality was graded on a three-point scale: good, poor, and unobservable. Results There were 17 patients for preoperative administration, 14 on the morning of the surgery, and 38 on the day before the surgery. The cystic duct could not be visualized in five patients because of insufficient dose, impacted gallstones, cystic duct stones, after endoscopic retrograde biliary drainage (ERBD), and severe cholecystitis. The observations were poor in 14 patients. The reasons for the poor visualization were cholecystitis after ERBD and a low signal-to-noise ratio due to intense light emission from the liver, which is a characteristic of preoperative administration. Conclusion The cystic and common bile ducts were well visualized using ICG fluorescence cholangiography, except in patients with impacted gallstones, cystic duct stones, ERBD, and severe cholecystitis. The most effective timing for ICG administration was the day before the surgery. ICG fluorescence cholangiography is not a substitute for intraoperative cholangiography or preoperative biliary imaging; however, it would be desirable in all patients who undergo cholecystectomy. Trial registration number jRCTs041180006.
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Affiliation(s)
- Shinichi Kinami
- Department of General and Gastroenterologic Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
- Department of Surgical Oncology, Kanazawa Medical University, Kahoku-gun, Japan
| | - Kaori Maruyama
- Department of General and Gastroenterologic Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
| | - Yuta Sannomiya
- Department of General and Gastroenterologic Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
| | - Hitoshi Saito
- Department of General and Gastroenterologic Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
| | - Hiroyuki Takamura
- Department of Surgical Oncology, Kanazawa Medical University, Kahoku-gun, Japan
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Elmeligy HA, Hassan HF, Amer MS, Ossama Y, Maher MA, Azzam AM, Rady M. Intravenous injection versus transhepatic intracholecystic injection of indocyanine green (ICG) to outline biliary tree during laparoscopic cholecystectomy. BMC Surg 2024; 24:330. [PMID: 39455983 PMCID: PMC11515391 DOI: 10.1186/s12893-024-02612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 10/04/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND To potentially lessen injuries and associated complications, fluorescence cholangiography has been suggested as a technique for enhancing the visualization and identification of extrahepatic biliary anatomy. The most popular way to administer indocyanine green (ICG) is intravenously, as there is currently little data on ICG injections directly into the gallbladder. In order to visualize extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC), we compared the two different ICG administration techniques. We also examined variations in visualization time, as well as the effectiveness, benefits, and drawbacks of each modality. METHODS In this prospective randomized clinical study, 60 consecutive adult patients with chronic and acute gallbladder disease were included. Our study conducted from 2022 to 2024 in Surgical Department of Theodor Bilharz Research Institute. Thirty patients underwent LC with intravenous ICG administration (IV-ICG), thirty patients received a direct injection of gallbladder through transhepatic ICG (IC-ICG) and Preoperative, intraoperative, and postoperative patient data were examined. RESULTS In terms of their perioperative and demographic features, the groups were similar. Without a statistically significant difference, the IV-ICG group's total operating time was less than that of the IC-ICG group (p 0.140). Compared to the transhepatic IC-ICG method, IV-ICG was more accurate in identifying the duodenum and the common hepatic duct (p = 0.029 and p = 0.016, respectively). In the transhepatic IC-ICG and IV-ICG groups, the cystic duct could be identified prior to dissection in 66.6% and 73.3% of cases, respectively, and this increased to 86.6% and 93.3% following dissection. In the transhepatic IC-ICG group, the common bile duct was visible in 93.3% of cases; in the IV-ICG group, it was visible in 90% of cases. Two cases in the IC-ICG group and every case following IV-ICG administration had liver fluorescence (6.6% versus 100%; p < 0.001). CONCLUSION The current study shows that for both administration methods, ICG-fluorescence cholangiography can be useful in identifying the extrahepatic biliary anatomy during Calot's triangle dissection. By avoiding hepatic fluorescence, the transhepatic IC-ICG route can increase the bile duct-to-liver contrast with less expense and no risk of hypersensitivity reactions than the intravenous ICG injection method. We recommend to use both techniques in case of acute cholecystitis with cystic duct obstruction. In cases of liver cirrhosis, we recommend transhepatic IC-ICG as IV-ICG is limited.
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Affiliation(s)
- Hesham A Elmeligy
- General Surgery Department, Theodor Bilharz Research Institute (TBRI), Giza, Egypt
| | - Hend F Hassan
- Anaesthesiology Department, Theodor Bilharz Research Institute (TBRI), Giza, Egypt
| | - Moshira S Amer
- Anaesthesiology Department, Theodor Bilharz Research Institute (TBRI), Giza, Egypt
| | - Yousra Ossama
- Pathology Department, October 6 University, Giza, Egypt
| | - Mohamed A Maher
- Anaesthesiology Department, Theodor Bilharz Research Institute (TBRI), Giza, Egypt
| | - Ahmed M Azzam
- Environmental Research Department, Theodor Bilharz Research Institute (TBRI), Giza, Egypt.
| | - Mahmoud Rady
- General Surgery Department, Theodor Bilharz Research Institute (TBRI), Giza, Egypt
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Zhou H, He Y, Chang L. Comparative study of Indocyanine Green fluorescence imaging versus conventional fiber-optic imaging in laparoscopic choledochotomy for stone extraction and immediate biliary incision suturing. Updates Surg 2024; 76:2247-2254. [PMID: 39271640 DOI: 10.1007/s13304-024-01993-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024]
Abstract
To explore the Advantages of Indocyanine Green (ICG) Fluorescence Imaging over Conventional Fiber-Optic Imaging in Laparoscopic Cholangiography and Immediate Suture for Stone Removal. The study is a randomized controlled descriptive research. Consecutive patient data were collected from October 2022 to January 2024 at the Second People's Hospital of Chengdu for those who underwent laparoscopic bile duct exploration and stone removal, totaling 72 cases. According to the order of admission, they were randomly assigned to either the study group or the control group, with 36 cases in each group. Ten minutes preoperatively, indocyanine green (ICG) was administered intravenously through a peripheral vein to the subjects in the study group, to enable real-time fluorescent tracing of the extrahepatic bile ducts during surgery. This study compares the efficiency of bile duct structure and boundary recognition, the timeliness of bile duct incision positioning, operative time, blood loss, and the incidence of bile duct injury between patients who were injected with ICG and those who were not. In addition, it assesses liver function and white blood-cell counts rechecked 24 h postoperatively, the duration of postoperative hospital stay, and the occurrence of bile leakage. The study included 72 patients, with 36 in the indocyanine green (ICG) fluorescence group and 36 in the conventional fiber-optic group, comprising 26 males and 46 females. There were 18 patients with a history of previous biliary exploration surgery and 23 who had undergone previous cholecystectomy. During surgery, ICG fluorescence was successfully visualized in all 36 cases of the ICG group, allowing for a clear view of the anatomical structure and boundaries of the extrahepatic bile ducts. Compared to the control group, the ICG fluorescence group demonstrated a reduction in the time required for identification of the biliary system and positioning of the bile duct incision, as well as a decrease in operative time and postoperative hospital stay; intraoperative blood loss and the incidence of bile leakage were also relatively reduced, with statistically significant differences (P < 0.05). However, there were no statistically significant differences in postoperative serum alanine aminotransferase levels, white blood-cell counts, direct bilirubin, and indirect bilirubin between the two groups (P > 0.05). One case of bile duct injury occurred in the control group. The application of ICG fluorescence navigation in laparoscopic cholecystectomy can effectively enhance the visibility of the bile ducts, rapidly identify the location for bile duct incision, and is conducive to reducing both the duration of surgery and postoperative hospital stay. It also minimizes intraoperative blood loss, prevents bile leakage and bile duct injuries. This program has demonstrating significant clinical value.
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Affiliation(s)
- Huabo Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Second People's Hospital of Chengdu, Chengdu, 610017, Sichuan, China.
| | - Yijia He
- Department of Hepatobiliary and Pancreatic Surgery, The Second People's Hospital of Chengdu, Chengdu, 610017, Sichuan, China
| | - Liuliu Chang
- Department of Hepatobiliary and Pancreatic Surgery, The Second People's Hospital of Chengdu, Chengdu, 610017, Sichuan, China
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Galaviz-Sosa ML, Herrero Fonollosa E, García-Domingo MI, Camps Lasa J, Galofré Recasens M, Arias Aviles M, Cugat Andorrà E. Indocyanine green in laparoscopic cholecystectomy: utility and correlation with a preoperative risk score. Cir Esp 2024; 102:533-539. [PMID: 39306239 DOI: 10.1016/j.cireng.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/24/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND This study aims to compare the visualization of the cystic duct-common bile duct junction with indocyanine green (ICG) among 3 groups of patients divided according to the difficulty of elective laparoscopic cholecystectomy. METHODS Conducted at a single center, this non-randomized, prospective, observational study encompassed 168 patients who underwent elective laparoscopic cholecystectomy and were assessed with a preoperative risk score to predict difficult cholecystectomies, including clinical factors and radiological findings. Three groups were identified: low, moderate, and high risk. A dose of 0.25 mg of IV ICG was administered during anesthesia induction and the different objectives were evaluated. RESULTS The visualization of the cystic duct-common bile duct junction was achieved in 28 (100%), 113 (91.1%), and 10 (63%) patients in the low, moderate, and high-risk groups, respectively. The high-risk group had longer total operative time, higher conversion, more complications and longer hospital stay. In the surgeon's subjective assessment, ICG was considered useful in 36% of the low-risk group, 58% in the moderate-risk group, and 69% in the high-risk group. Additionally, there were no cases where ICG modified the surgeon's surgical approach in the low-risk group, compared to 11% in the moderate-risk group and 25% in the high-risk group (p < 0.01). CONCLUSIONS The results of this study confirm that in the case of difficult cholecystectomies, the visualization of the cystic duct-common bile duct junction is achieved in 63% of cases and prompts a modification of the surgical procedure in one out of four patients.
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Affiliation(s)
- Maria Luisa Galaviz-Sosa
- Departamento de Cirugía General y Digestiva, Hospital Universitari Mútua Terrassa, Barcelona, Spain.
| | - Eric Herrero Fonollosa
- Departamento de Cirugía General y Digestiva, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | | | - Judith Camps Lasa
- Departamento de Cirugía General y Digestiva, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - María Galofré Recasens
- Departamento de Cirugía General y Digestiva, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Melissa Arias Aviles
- Departamento de Cirugía General y Digestiva, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Esteban Cugat Andorrà
- Departamento de Cirugía General y Digestiva, Hospital Universitari Mútua Terrassa, Barcelona, Spain; Departamento de Cirugía General y Digestiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Tang Y, Liu R, Liu H, Peng R, Su B, Tu D, Wang S, Chen C, Jiang G, Jin S, Cao J, Zhang C, Bai D. Effects of Indocyanine Green (ICG) Imaging-Assisted Cholecystectomy on Intraoperative and Postoperative Complications: A meta-Analysis. Surg Innov 2024; 31:362-372. [PMID: 38656291 DOI: 10.1177/15533506241246335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Accurate recognition of Calot's triangle during cholecystectomy is important in preventing intraoperative and postoperative complications. The use of indocyanine green (ICG) fluorescence imaging has become increasingly prevalent in cholecystectomy procedures. Our study aimed to evaluate the specific effects of ICG-assisted imaging in reducing complications. MATERIALS AND METHODS A comprehensive search of databases including PubMed, Web of Science, Europe PMC, and WANFANGH DATA was conducted to identify relevant articles up to July 5, 2023. Review Manager 5.3 software was applied to statistical analysis. RESULTS Our meta-analysis of 14 studies involving 3576 patients compared the ICG group (1351 patients) to the control group (2225 patients). The ICG group had a lower incidence of postoperative complications (4.78% vs 7.25%; RR .71; 95%CI: .54-.95; P = .02). Bile leakage was significantly reduced in the ICG group (.43% vs 2.02%; RR = .27; 95%CI: .12-.62; I2 = 0; P = .002), and they also had a lower bile duct drainage rate (24.8% vs 31.8% RR = .64, 95% CI: .44-.91, P = .01). Intraoperative complexes showed no statistically significant difference between the 2 groups (1.16% vs 9.24%; RR .17; 95%CI .03-1.02), but the incidence of intraoperative bleeding is lower in the ICG group. CONCLUSION ICG fluorescence imaging-assisted cholecystectomy was associated with a range of benefits, including a lower incidence of postoperative complications, decreased rates of bile leakage, reduced bile duct drainage, fewer intraoperative complications, and reduced intraoperative bleeding.
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Affiliation(s)
- Yuhong Tang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Renjie Liu
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Huanxiang Liu
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Rui Peng
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Bingbing Su
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Daoyuan Tu
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Shunyi Wang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Chen Chen
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Guoqing Jiang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
- Subei People's Hospital Hepatobiliary Surgery, Institute of General Surgery, Yangzhou, China
| | - Shengjie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
- Subei People's Hospital Hepatobiliary Surgery, Institute of General Surgery, Yangzhou, China
| | - Jun Cao
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Chi Zhang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
- Subei People's Hospital Hepatobiliary Surgery, Institute of General Surgery, Yangzhou, China
| | - Dousheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
- Subei People's Hospital Hepatobiliary Surgery, Institute of General Surgery, Yangzhou, China
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8
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Alexander P, Marcucci V, Torres P, Cassidy J, Kipnis S, Arumugam D. Enhancing biliary structure identification using percutaneous cholecystostomy drain delivery of indocyanine green: a glowing two case review. J Surg Case Rep 2024; 2024:rjae275. [PMID: 38706473 PMCID: PMC11066793 DOI: 10.1093/jscr/rjae275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/10/2024] [Indexed: 05/07/2024] Open
Abstract
The use of indocyanine green for fluorescent cholangiography in patients with cholecystitis initially treated with percutaneous cholecystostomy drainage catheters was described in this two case series. Two patients underwent robotic assisted cholecystectomy with fluorescent cholangiography and indocyanine green through percutaneous cholecystostomy drainage catheters. The patients were diagnosed with acute cholecystitis. Directed injection of indocyanine green allowed for direct visualization of the biliary system allowing for a safe identification of the critical view of safety. Injection of indocyanine green for fluorescent cholangiography through percutaneous cholecystostomy drainage catheters is reliable to assess the critical view of safety and allows for improved identification of the biliary tree anatomy. Administration of indocyanine green through the percutaneous cholecystostomy drainage catheters avoided background hepatic fluorescence and increased contrast between biliary structures.
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Affiliation(s)
- Peter Alexander
- Department of Surgery, St. George’s University, School of Medicine, St. George’sGrenada
| | - Vincent Marcucci
- Department of Surgery, Jersey Shore University Medical Center, 1945 New Jersey 33, Neptune, NJ, United States
| | - Patricia Torres
- Department of Surgery, Jersey Shore University Medical Center, 1945 New Jersey 33, Neptune, NJ, United States
| | - Jillian Cassidy
- Department of Surgery, Jersey Shore University Medical Center, 1945 New Jersey 33, Neptune, NJ, United States
| | - Seth Kipnis
- Department of Surgery, St. George’s University, School of Medicine, St. George’sGrenada
- Department of Surgery, Jersey Shore University Medical Center, 1945 New Jersey 33, Neptune, NJ, United States
| | - Dena Arumugam
- Department of Surgery, St. George’s University, School of Medicine, St. George’sGrenada
- Department of Surgery, Jersey Shore University Medical Center, 1945 New Jersey 33, Neptune, NJ, United States
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9
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Symeonidis S, Mantzoros I, Anestiadou E, Ioannidis O, Christidis P, Bitsianis S, Bisbinas V, Zapsalis K, Karastergiou T, Athanasiou D, Apostolidis S, Angelopoulos S. Near-infrared cholangiography with intragallbladder indocyanine green injection in minimally invasive cholecystectomy. World J Gastrointest Surg 2024; 16:1017-1029. [PMID: 38690057 PMCID: PMC11056669 DOI: 10.4240/wjgs.v16.i4.1017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/02/2024] [Accepted: 03/18/2024] [Indexed: 04/22/2024] Open
Abstract
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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Affiliation(s)
- Savvas Symeonidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Ioannis Mantzoros
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Elissavet Anestiadou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Panagiotis Christidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stefanos Bitsianis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Vasiliki Bisbinas
- ENT Department, Royal Cornwall Hospitals NHS Trust, Cornwall TR1 3LJ, United Kingdom
| | - Konstantinos Zapsalis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Trigona Karastergiou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Dimitra Athanasiou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stylianos Apostolidis
- 1st Propedeutic Surgical Department, University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Stamatios Angelopoulos
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
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10
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Hou YK, Liu WK, Gao YB, Tian XD, Yang YM. Enhanced fluorescence cholangiography with indocyanine green: A methodology for reducing the potential hazard of bile duct injury during laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 2024:S1499-3872(24)00065-1. [PMID: 38704349 DOI: 10.1016/j.hbpd.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/28/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Yu-Kun Hou
- Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital, Beijing 100034, China
| | - Wei-Kang Liu
- Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital, Beijing 100034, China
| | - Yi-Bo Gao
- Kunming Medical University, Kunming 650500, China
| | - Xiao-Dong Tian
- Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital, Beijing 100034, China
| | - Yin-Mo Yang
- Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital, Beijing 100034, China.
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11
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Symeonidis S, Mantzoros I, Anestiadou E, Ioannidis O, Christidis P, Bitsianis S, Zapsalis K, Karastergiou T, Athanasiou D, Apostolidis S, Angelopoulos S. Biliary Anatomy Visualization and Surgeon Satisfaction Using Standard Cholangiography versus Indocyanine Green Fluorescent Cholangiography during Elective Laparoscopic Cholecystectomy: A Randomized Controlled Trial. J Clin Med 2024; 13:864. [PMID: 38337557 PMCID: PMC10856121 DOI: 10.3390/jcm13030864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Intraoperative biliary anatomy recognition is crucial for safety during laparoscopic cholecystectomy, since iatrogenic bile duct injuries represent a fatal complication, occurring in up to 0.9% of patients. Indocyanine green fluorescence cholangiography (ICG-FC) is a safe and cost-effective procedure for achieving a critical view of safety and recognizing early biliary injuries. The aim of this study is to compare the perioperative outcomes, usefulness and safety of standard intraoperative cholangiography (IOC) with ICG-FC with intravenous ICG. Methods: Between 1 June 2021 and 31 December 2022, 160 patients undergoing elective LC were randomized into two equal groups: Group A (standard IOC) and group B (ICG-FC with intravenous ICG). Results: No significant difference was found between the two groups regarding demographics, surgery indication or surgery duration. No significant difference was found regarding the visualization of critical biliary structures. However, the surgeon satisfaction and cholangiography duration presented significant differences in favor of ICG-FC. Regarding the inflammatory response, a significant difference between the two groups was found only in postoperative WBC levels. Hepatic and renal function test results were not significantly different between the two groups on the first postoperative day, except for direct bilirubin. No statistically significant difference was noted regarding 30-day postoperative complications, while none of the complications noted included bile duct injury events. Conclusions: ICG-FC presents equivalent results to IOC regarding extrahepatic biliary visualization and postoperative complications. However, more studies need to be performed in order to standardize the optimal dose, timing and mode of administration.
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Affiliation(s)
- Savvas Symeonidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Ioannis Mantzoros
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Elissavet Anestiadou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Orestis Ioannidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Panagiotis Christidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Stefanos Bitsianis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Konstantinos Zapsalis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Trigona Karastergiou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Dimitra Athanasiou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Stylianos Apostolidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Stamatios Angelopoulos
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
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12
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Esposito C, Rathod KJ, Cerulo M, Del Conte F, Saxena R, Coppola V, Sinha A, Esposito G, Escolino M. Indocyanine green fluorescent cholangiography: The new standard practice to perform laparoscopic cholecystectomy in pediatric patients. A comparative study with conventional laparoscopic technique. Surgery 2024; 175:498-504. [PMID: 38007385 DOI: 10.1016/j.surg.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/01/2023] [Accepted: 10/25/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND This study aimed to compare outcomes of standard laparoscopic cholecystectomy and indocyanine green fluorescent cholangiography laparoscopic cholecystectomy over a 10-year period. METHODS From 2013 to 2023, 173 laparoscopic cholecystectomies were performed in 2 pediatric surgery units: 83 using standard technique (G1) and 90 using indocyanine green fluorescent cholangiography (G2). Patients included 96 girls and 77 boys, with a median age of 12.3 years (range 4-17) and a median weight of 51 kg (range 19-114). The 2 groups were compared regarding the following: (1) perioperative complications rate; (2) overall length of surgery (T1); (3) length of cystic duct isolation, clipping, and sectioning (T2); (4) time of gallbladder removal (T3); (5) degree of visualization of biliary tree; (6) safety and feasibility of indocyanine green fluorescent cholangiography; (7) incidence of anatomical anomalies detected intraoperatively. RESULTS All laparoscopic cholecystectomies were accomplished without conversion to open. The perioperative complications rate was significantly higher in G1 compared with G2 (12% vs 0%; P = .0007). Median T1, T2, and T3 were significantly longer in G1 (90, 37, 35 minutes) compared with G2 (55, 17, 19 minutes) (P = .0001), respectively. The visualization rate of the complete biliary tree was significantly higher in G2 (98.8%) than in G1 (80.7%) (P = .0001). No adverse reactions to indocyanine green were recorded. The incidence of biliary anomalies detected intraoperatively was significantly higher in G2 (7.8%) than in G1 (1.2%) (P = .03). CONCLUSION Indocyanine green fluorescent cholangiography can be considered the new standard practice to perform laparoscopic cholecystectomy in pediatrics. Indocyanine green fluorescence provided superior visualization of biliary anatomy, increased detection of anatomic variants, faster procedure, and fewer complications compared with conventional technique. Indocyanine green fluorescent cholangiography was safe, feasible, simple, inexpensive, and a timesaving tool.
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Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy.
| | - Kirtikumar J Rathod
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mariapina Cerulo
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Fulvia Del Conte
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Rahul Saxena
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vincenzo Coppola
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Maria Escolino
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
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13
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Ker CG. Hepatobiliary surgery in Taiwan: The past, present, and future. Part I; biliary surgery. FORMOSAN JOURNAL OF SURGERY 2024; 57:1-10. [DOI: 10.1097/fs9.0000000000000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2024] Open
Abstract
Abstract
In Taiwan, most surgical services were mainly provided by Japanese or Western surgeons before World War II. Tsuchiya Kunita first reported surgical treatment of gallstone diseases in 1915 in Taiwan. After World War II, experienced Japanese surgeons returned to Japan, and well-trained surgeons moved to Taiwan from different hospitals in Mainland China after 1949. In 1954, Liao had reported surgical gallstone diseases treated by cholecytostomy, cholecystectomy, and cholecystogastrostomy or cholecystoduodenostomy from National Taiwan University Hospital (Formos J Surg. 1954;53:833–4). By using of operative cholangiography, diagnosis and removal of intrahepatic stones could be done through choledochostomy reported first by Lee HC from National Defense Medical Center in 1966 and 1968 (Chin Med J ROC. 1966;13:301–8; Chin Med J ROC. 1968;15:124–34). Wei from the National Taiwan University Hospital reported the first left hepatectomy for treating hepatolithiasis on one patient among his series in 1971 (Formos J Surg. 1971;4:178–96). Treatments of hepatolithiasis were well analyzed by Wen and Lee from Triservice General Hospital and Veterans General Hospital in 1972 (Ann Surg. 1972;175:166–77). Hwang was the first to use choledochofiberscope for removing retained stones since 1974 reported from Show Chwan Memorial Hospital in 1978 (Am J Surg. 1978;139:860–4). The first laparoscopic cholecystectomy was performed by Huang from Taipei Cathay General Hospital in 1990 in Taiwan (J Formos Med Assoc. 1991;90:893–9). Nowadays, Taiwan hepatobiliary surgeons were extensively using either laparoscopic or robotic surgery for treatment of hepatobiliary diseases.
In conclusion, we should never forget the great contributions from many clinics in rural villages hosted by Christian or Catholicism organizations in Taiwan hundred years ago. We should express our appreciations to the history of the evolutions of biliary surgical skills. In Taiwan, a great surgeon today is always standing on the shoulders of our ancient giants, our surgical teachers.
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14
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Xie Q, Yang M, Jiang K, Zhang L, Mao T, Gao F. Laparoscopic cholecystectomy assisted by combined intravenous and intracholecystic fluorescent cholangiography: a case report. J Int Med Res 2023; 51:3000605231216396. [PMID: 38064274 PMCID: PMC10710120 DOI: 10.1177/03000605231216396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
This case report describes a laparoscopic approach using fluorescence imaging guidance to treat gangrenous cholecystitis with perforation (GCP). A male patient in his early 60s presented with 3 days of right upper abdominal pain. Computed tomography and ultrasonography findings were consistent with a stone incarcerated in the gallbladder neck, GCP, and localized peritonitis. Percutaneous gallbladder drainage was initially performed, followed by laparoscopic cholecystectomy 7 days later, using combined intravenous and intracholecystic fluorescent cholangiography. This technique allowed visualization of the cystic and common bile ducts during surgery and enabled safe removal of the diseased gallbladder. The patient recovered well without complications, and reported no pain or discomfort at a 2-month follow-up.
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Affiliation(s)
- Qingyun Xie
- Department of Hepato-Pancreato-Biliary Surgery, the People’s Hospital of Leshan, Leshan, China
| | - Manyu Yang
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Kangyi Jiang
- Department of Hepato-Pancreato-Biliary Surgery, the People’s Hospital of Leshan, Leshan, China
| | - Ling Zhang
- Department of Hepato-Pancreato-Biliary Surgery, the People’s Hospital of Leshan, Leshan, China
| | - Tianyang Mao
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Fengwei Gao
- Department of Hepato-Pancreato-Biliary Surgery, the People’s Hospital of Leshan, Leshan, China
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15
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Liu H, Kuang J, Xu Y, Li T, Li P, Huang Z, Zhang S, Weng J, Lai Y, Wu Z, Lin F, Gu W, Huang Y. Investigation of the optimal indocyanine green dose in real-time fluorescent cholangiography during laparoscopic cholecystectomy with an ultra-high-definition 4K fluorescent system: a randomized controlled trial. Updates Surg 2023; 75:1903-1910. [PMID: 37314620 PMCID: PMC10543949 DOI: 10.1007/s13304-023-01557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
This study aimed to investigate the indocyanine green (ICG) dose in real-time fluorescent cholangiography during laparoscopic cholecystectomy (LC) with a 4K fluorescent system. A randomized controlled clinical trial was conducted in patients who underwent LC for treatment of cholelithiasis. Using the OptoMedic 4K fluorescent endoscopic system, we compared four different doses of ICG (1, 10, 25, and 100 µg) administered intravenously within 30 min preoperatively and evaluated the fluorescence intensity (FI) of the common bile duct and liver background and the bile-to-liver ratio (BLR) of the FI at three timepoints: before surgical dissection of the cystohepatic triangle, before clipping the cystic duct, and before closure. Forty patients were randomized into four groups, and 33 patients were fully analyzed, with 10 patients in Group A (1 µg), 7 patients in Group B (10 µg), 9 patients in Group C (25 µg), and 7 patients in Group D (100 µg). The preoperative baseline characteristics were compared among groups (p > 0.05). Group A showed no or minimal FI in the bile duct and liver background, while Group D showed extremely high FIs in the bile duct and in the liver background at the three timepoints. Groups B and C presented with visible FI in the bile duct and low FI in the liver background. With increasing ICG doses, the FIs in the liver background and bile duct gradually increased at the three timepoints. The BLR, however, showed no increasing trend with an increasing ICG dose. A relatively high BLR on average was found in Group B, without a significant difference compared to the other groups (p > 0.05). An ICG dose ranging from 10 to 25 µg by intravenous administration within 30 min preoperatively was appropriate for real-time fluorescent cholangiography in LC with a 4K fluorescent system. Registration: This study was registered in the Chinese Clinical Trial Registry (ChiCTR No: ChiCTR2200064726).
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Affiliation(s)
- Hui Liu
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China
- Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Guangzhou, China
| | - Jiao Kuang
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China
- Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Guangzhou, China
| | - Yujie Xu
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China
- Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Guangzhou, China
| | - Tianyang Li
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Peilin Li
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Zisheng Huang
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Shuai Zhang
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China
- Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Guangzhou, China
| | - Jiefeng Weng
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China
- Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Guangzhou, China
| | - Yueyuan Lai
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China
- Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Guangzhou, China
| | - Zhaofeng Wu
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China
- Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Guangzhou, China
| | - Fan Lin
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China
- Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Guangzhou, China
| | - Weili Gu
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China.
- Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Guangzhou, China.
| | - Yu Huang
- Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, No.1 Panfu Road, Yuexiu District, Guangzhou, 510180, Guangdong, People's Republic of China.
- Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Guangzhou, China.
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16
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Marchegiani F, Conticchio M, Zadoroznyj A, Inchingolo R, Memeo R, De'angelis N. Detection and management of bile duct injury during cholecystectomy. Minerva Surg 2023; 78:545-557. [PMID: 36883937 DOI: 10.23736/s2724-5691.23.09866-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Cholecystectomy represents one of the most performed surgical procedures. Bile duct injuries (BDIs) are a dangerous complication of this intervention. With the advent of the laparoscopy, the rate of BDIs showed a growing trend that was partially justified by the learning curve of this technique. EVIDENCE ACQUISITION A literature search was conducted on Embase, Medline, and Cochrane databases to identify studies published up to October 2022 that analyzed the intraoperative detection and management of BDIs diagnosed during cholecystectomy. EVIDENCE SYNTHESIS According to the literature, approximately 25% of BDIs is diagnosed during the laparoscopic cholecystectomy. In the clinical suspicion of BDI, an intraoperative cholangiography is performed to confirm it. Complimentary technology, such as near-infrared cholangiography, can be also adopted. Intraoperative ultrasound represents a useful tool to furtherly define the biliary and the vascular anatomy. The proper classification of the type of BDI allows to identify the correct treatment. When a good expertise in hepato-pancreato-biliary surgery is available, a direct repair is performed with good outcomes both in case of simple and complex lesions. When the local resources are limited or there is a lack of dedicated surgical experience, patient referral to a reference center shows better outcomes. In particular, complex vasculo-biliary injuries require a highly specialized treatment. The key elements to transfer the patients are a good documentation of the injury, a proper drainage of the abdomen, and an antibiotic therapy. CONCLUSIONS BDI management requires a proper diagnostic process and prompt treatment to reduce the morbidity and mortality of this feared complication occurring during cholecystectomy.
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Affiliation(s)
- Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Maria Conticchio
- Unit of Hepato-Pancreato-Biliary Surgery, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Alizée Zadoroznyj
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Nicola De'angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France -
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17
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Alius C, Serban D, Bratu DG, Tribus LC, Vancea G, Stoica PL, Motofei I, Tudor C, Serboiu C, Costea DO, Serban B, Dascalu AM, Tanasescu C, Geavlete B, Cristea BM. When Critical View of Safety Fails: A Practical Perspective on Difficult Laparoscopic Cholecystectomy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1491. [PMID: 37629781 PMCID: PMC10456257 DOI: 10.3390/medicina59081491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a narrative review which discusses from a contextual point of view the need to standardise the surgical approach in difficult laparoscopic cholecystectomies, the main strategic operative concepts and techniques, complementary visualisation aids for the delineation of anatomical landmarks, and the importance of cognitive maps and algorithms in performing safer LC. Extensive research was carried out in the PubMed, Web of Science, and Elsevier databases using the terms "difficult cholecystectomy", "bile duct injuries", "safe cholecystectomy", and "laparoscopy in acute cholecystitis". The key content and findings of this research suggest there is high intersocietal variation in approaching and performing LC, in the use of visualisation aids, and in the application of safety concepts. Limited papers offer guidelines based on robust data and a timid recognition of the human factors and ergonomic concepts in improving the outcomes associated with difficult cholecystectomies. This paper highlights the most relevant recommendations for dealing with difficult laparoscopic cholecystectomies.
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Affiliation(s)
- Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dan Georgian Bratu
- Faculty of Medicine, University “Lucian Blaga”, 550169 Sibiu, Romania; (D.G.B.)
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021Bucharest, Romania;
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Geta Vancea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Third Clinical Infectious Disease Department, Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babes”, 030303 Bucharest, Romania
| | - Paul Lorin Stoica
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Ion Motofei
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Crenguta Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania;
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
| | - Bogdan Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Ciprian Tanasescu
- Faculty of Medicine, University “Lucian Blaga”, 550169 Sibiu, Romania; (D.G.B.)
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
| | - Bogdan Geavlete
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
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18
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Tzeng WJ, Lin YH, Hou TY, Yin SM, Lin YC, Liu YW, Liu YY, Li WF, Wang CC, Marescaux J, Diana M. Near-infrared cholangiography can increase the chance of success in laparoscopic approaches to common bile duct stones, even with previous abdominal surgery. BMC Surg 2023; 23:203. [PMID: 37454060 DOI: 10.1186/s12893-023-02103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The treatment of common bile duct (CBD) stones with minimally invasive surgery (MIS) is more technical demanding than laparoscopic cholecystectomy (LC), especially in patients with history of previous abdominal surgery, cholangitis or cholecystitis. Near-infrared (NIR) cholangiography via systemic or biliary tree administration of indocyanine green (ICG), which enhances the visualization of the biliary tree anatomy, may increase the reassurance of CBD localization. The aim of this study was to identify the benefit of near-infrared cholangiography for laparoscopic common bile duct exploration (LCBDE). METHODS Three groups of CBD stone patients were included in this retrospective study depending on the surgical methods: 1) open choledocholithotomy (OCC), 2) laparoscopic choledocholithotomy (LCC), and 3) near-infrared cholangiography-assisted laparoscopic choledocholithotomy (NIR-CC). For the NIR-CC group, either 3 ml (concentration: 2.5 mg/mL) of ICG were intravenously administered or 10 ml (concentration: 0.125 mg/mL) of ICG were injected directly into the biliary tree. The enhancement rate of the cystic duct (CD), CBD, the upper and lower margin of the CBD were compared using white light image. RESULTS A total of 187 patients with a mean age of 68.3 years were included (OCC, n = 56; LCC, n = 110; NIR-CC, n = 21). The rate of previous abdominal surgery was significantly lower in the LCC group. The conversion rate was similar between the LCC and the NIR CC groups (p = 0.746). The postoperative hospital stay was significantly longer in the OCC group. No differences in morbidity and mortality were found between the three groups. In the NIR-CC group, the localization of CBD was as high as 85% compared to 24% with white light imaging. CONCLUSIONS Near-infrared cholangiography helps increase the chance of success in minimally invasive approaches to CBD stones even in patients with previous abdominal surgeries, without increasing the rate of conversion.
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Affiliation(s)
- Wei-Juo Tzeng
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yu-Hung Lin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Teng-Yuan Hou
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Shih-Min Yin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yu-Cheng Lin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yueh-Wei Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yu-Yin Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan.
| | - Wei-Feng Li
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Chih-Chi Wang
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Lab, Photonics for Health, University of Strasbourg, Strasbourg, France
- Department of Surgery, University Hospital of Strasbourg, Strasbourg, France
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19
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Abdelrahman H, El-Menyar A, Peralta R, Al-Thani H. Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients. World J Gastrointest Surg 2023; 15:757-775. [PMID: 37342859 PMCID: PMC10277941 DOI: 10.4240/wjgs.v15.i5.757] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/18/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
Background: Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging. Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries. Bowel anastomosis after trauma-related resection is associated with a high rate of leakage. The ability of the surgeon’s bare eye to determine bowel viability remains limited, and the need for a more standardized objective assessment has not yet been fulfilled. Hence, there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize trauma-associated complications. Indocyanine green (ICG) coupled with fluorescence angiography is a potential solution for this problem. ICG is a fluorescent dye that responds to near-infrared irradiation. Methods: We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery. Discussion: ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance. However, there is a paucity of information regarding the use of this technology to treat traumas. Recently, angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions, leading to fewer cases of anastomotic insufficiency. This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety. However, there is no consensus on the ideal dose, time, and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings. Conclusions: There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection. This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients’ operative care and safety in the field of trauma surgery.
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Affiliation(s)
| | - Ayman El-Menyar
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Ruben Peralta
- Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Hassan Al-Thani
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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20
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Wang W, Huang H, He K, Wang L, Su S, Zhang Z, Wang P, Guo B, Ren X, Li O. Detection of the communicating accessory bile duct in laparoscopic resection of residual gallbladder by the combination of the indocyanine green fluorescence cholangiography and the intraoperative cholangiography: A case report. Photodiagnosis Photodyn Ther 2023; 42:103587. [PMID: 37146895 DOI: 10.1016/j.pdpdt.2023.103587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND The partial cholecystectomy may be performed while in complicated laparoscopic cholecystectomy (LC). Biliary anomalies especially the accessory bile duct are established high risk of bile duct injury (BDI) in LC. Laparoscopic resection of residual gallbladder is a challenging procedure and extremely vulnerable to BDI. We report the execution of a laparoscopic resection of residual gallbladder with a communicating accessory bile duct using indocyanine green (ICG) fluorescence cholangiography and the intraoperative cholangiography (IOC). A case that has not been reported previously. PRESENTATION OF CASE A 29-year-old female with history of laparoscopic partial cholecystectomy was admitted in our hospital. Magnetic resonance cholangiopancreatography (MRCP) revealed the residual gallbladder with an accessory bile duct. Considering the complexity of this patient, we performed a laparoscopic surgery using ICG fluorescence cholangiography. ICG was injected intravenously 1h before the surgery, the residual gallbladder and the extrahepatic biliary structures including the accessory bile duct were imaged in green in fluorescence imaging that could be recognized clearly. IOC revealed that residual gallbladder communicated with intrahepatic bile duct through the accessory bile duct and drained into the common bile duct (CBD). The entire procedure was performed smoothly and successfully without bile duct injuries. DISCUSSION Laparoscopic resection of residual gallbladder is a challenging procedure. Fluorescence cholangiography using ICG is regarded as a novel technique that could provide a real-time imaging intraoperative, which allowed to recognize and identify the residual gallbladder and the extrahepatic bile duct. IOC is also important in identifying a communicating accessory bile duct. Under the guidance of them, we completed this laparoscopic surgery. CONCLUSIONS The combination of fluorescence cholangiography using ICG and IOC have profound significance in complicated LC.
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Affiliation(s)
- Wanli Wang
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China.
| | - Hansheng Huang
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Kai He
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Liangjie Wang
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Song Su
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Zhiyong Zhang
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Piao Wang
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Bing Guo
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Xiaobin Ren
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Ou Li
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
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21
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Lie H, Irawan A, Sudirman T, Budiono BP, Prabowo E, Jeo WS, Rudiman R, Sitepu RK, Hanafi RV, Hariyanto TI. Efficacy and Safety of Near-Infrared Florescence Cholangiography Using Indocyanine Green in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2023; 33:434-446. [PMID: 36576572 DOI: 10.1089/lap.2022.0495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Achieving critical view of safety is a key for a successful laparoscopic cholecystectomy (LC) procedure. Near-infrared fluorescence cholangiography using indocyanine green (NIF-ICG) in LC has been extensively used and accepted as beneficial auxiliary tool to visualize extrahepatic biliary structures intraoperatively. This study aimed to analyze its safety and efficacy. Materials and Methods: Searching for potential articles up to March 25, 2022 were conducted on PubMed, Europe PMC, and ClinicalTrials.gov databases. Articles on the near infrared fluorescence during laparoscopy cholecystectomy were collected. Review Manager 5.4 software was utilized to perform the statistical analysis. Results: Twenty-two studies with a total of 3457 patients undergo LC for the analysis. Our meta-analysis revealed that NIF-ICG technique during LC was associated with shorter operative time (Std. Mean Difference -0.86 [95% confidence interval (CI) -1.49 to -0.23], P = .007, I2 = 97%), lower conversion rate (risk ratio [RR] 0.28 [95% CI 0.16-0.50], P < .0001, I2 = 0%), higher success in identification of cystic duct (CD) (RR 1.24 [95% CI 1.07-1.43], P = .003, I2 = 94%), higher success in identification of common bile duct (CBD) (RR 1.31 [95% CI 1.07-1.60], P = .009, I2 = 90%), and shorter time to identify biliary structures (Std. Mean Difference -0.52 [95% CI -0.78 to -0.26], P < .0001, I2 = 0%) compared with not using NIF-ICG. Conclusions: NIF-ICG technique beneficial for early real-time visualization of biliary structure, shorter operative time, and lower risk of conversion during LC. Larger randomized clinical trials are still needed to confirm the results of our study.
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Affiliation(s)
- Hendry Lie
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Andry Irawan
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Taufik Sudirman
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Bernardus Parish Budiono
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Diponegoro University, Dr. Kariadi General Hospital, Semarang, Indonesia
| | - Erik Prabowo
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Diponegoro University, Dr. Kariadi General Hospital, Semarang, Indonesia
| | - Wifanto Saditya Jeo
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ryanto Karobuana Sitepu
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Ricarhdo Valentino Hanafi
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Timotius Ivan Hariyanto
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
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22
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Huang H, Du D, Wang Z, Xie Y, Ni Z, Li X, Jin H. Application of Intraoperative Fluorescence Imaging with Indocyanine Green in the Difficult Gallbladder: A Comparative Study between Indocyanine Green-Guided Fluorescence Cholangiography and Conventional Surgery. J Laparoendosc Adv Surg Tech A 2022; 33:404-410. [PMID: 36577039 DOI: 10.1089/lap.2022.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: In the difficult gallbladder, the rate of bile duct injury (BDI) remains high. To lessen iatrogenic biliary injury, we attempted to utilize indocyanine green (ICG)-guided fluorescence cholangiography during surgery to illuminate the extrahepatic biliary tract. Materials and Methods: According to admission criteria, 38 patients were diagnosed with difficult gallbladder and underwent percutaneous transhepatic gallbladder drainage (PTGBD). Consecutive patients who underwent ICG-assisted laparoscopic biliary surgery (n = 18, ICG group) or conventional laparoscopic biliary surgery (n = 20, white light [WL group) were enrolled in this study. ICG group received ICG fluorescent cholangiography via PTGBD tube during operation; 16 cases of laparoscopic cholecystectomy (LC) and 2 cases of LC plus laparoscopic common bile duct exploration (LC+LCBDE) were performed by fluorescent laparoscopy. In the WL group, 16 cases of LC, 1 case of laparoscopic subtotal cholecystectomy (LSC), and 3 cases of LC+LCBDE were performed under white light without ICG. Result: The biliary system was successfully established in the ICG group. Compared with the WL group, the anatomy of the Calot's triangle with severe abdominal adhesion or local inflammatory edema was more clearly displayed by fluorescence. Laparoscopic surgery was completed in both groups without conversion to laparotomy. There were no significant differences in surgery-related complications (P = .232) and postoperative hospital stay (P = .074) between the two groups. However, compared with the WL group, the ICG group had less intraoperative blood loss (P = .002) and shorter operation duration (P = .006). Conclusion: ICG fluorescence cholangiography has good clinical application value in the difficult gallbladder, which can avoid iatrogenic BDI, reduce surgery-related complications and intraoperative blood loss, and shorten the duration of surgery.
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Affiliation(s)
- Hai Huang
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
| | - Danwei Du
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
| | - Ziqiang Wang
- Department of Breast Armor Surgery, the First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Yangyang Xie
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
| | - Zhongkai Ni
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
| | - Xiaowen Li
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
| | - Haimin Jin
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
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23
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Morales-Conde S, Licardie E, Alarcón I, Balla A. Indocyanine green (ICG) fluorescence guide for the use and indications in general surgery: recommendations based on the descriptive review of the literature and the analysis of experience. Cir Esp 2022; 100:534-554. [PMID: 35700889 DOI: 10.1016/j.cireng.2022.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/26/2021] [Indexed: 06/15/2023]
Abstract
Indocyanine Green is a fluorescent substance visible in near-infrared light. It is useful for the identification of anatomical structures (biliary tract, ureters, parathyroid, thoracic duct), the tissues vascularization (anastomosis in colorectal, esophageal, gastric, bariatric surgery, for plasties and flaps in abdominal wall surgery, liver resection, in strangulated hernias and in intestinal ischemia), for tumor identification (liver, pancreas, adrenal glands, implants of peritoneal carcinomatosis, retroperitoneal tumors and lymphomas) and sentinel node identification and lymphatic mapping in malignant tumors (stomach, breast, colon, rectum, esophagus and skin cancer). The evidence is very encouraging, although standardization of its use and randomized studies with higher number of patients are required to obtain definitive conclusions on its use in general surgery. The aim of this literature review is to provide a guide for the use of ICG fluorescence in general surgery procedures.
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Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain; Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Eugenio Licardie
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain.
| | - Andrea Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain; UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Civitavecchia, Rome, Italy.
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24
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Castagneto-Gissey L, Russo MF, Iodice A, Casella-Mariolo J, Serao A, Picchetto A, D’Ambrosio G, Urciuoli I, De Luca A, Salvati B, Casella G. Intracholecystic versus Intravenous Indocyanine Green (ICG) Injection for Biliary Anatomy Evaluation by Fluorescent Cholangiography during Laparoscopic Cholecystectomy: A Case-Control Study. J Clin Med 2022; 11:jcm11123508. [PMID: 35743577 PMCID: PMC9224771 DOI: 10.3390/jcm11123508] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Fluorescence cholangiography has been proposed as a method for improving the visualization and identification of extrahepatic biliary anatomy in order to possibly reduce injuries and related complications. The most common method of indocyanine green (ICG) administration is the intravenous route, whereas evidence on direct ICG injection into the gallbladder is still quite limited. We aimed to compare the two different methods of ICG administration in terms of the visualization of extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC), analyzing differences in the time of visualization, as well as the efficacy, advantages, and disadvantages of both modalities. (2) Methods: A total of 35 consecutive adult patients affected by acute or chronic gallbladder disease were enrolled in this prospective case−control study. Seventeen patients underwent LC with direct gallbladder ICG injection (IC-ICG) and eighteen subjects received intravenous ICG administration (IV-ICG). (3) Results: The groups were comparable with regard to their demographic and perioperative characteristics. The IV-ICG group had a significantly shorter overall operative time compared to the IC-ICG group (p = 0.017). IV-ICG was better at delineating the duodenum and the common hepatic duct compared to the IC-ICG method (p = 0.009 and p = 0.041, respectively). The cystic duct could be delineated pre-dissection in 76.5% and 66.7% of cases in the IC-ICG and IV-ICG group, respectively, and this increased to 88.2% and 83.3% after dissection. The common bile duct could be highlighted in 76.5% and 77.8% of cases in the IC-ICG and IV-ICG group, respectively. Liver fluorescence was present in one case in the IC-ICG group and in all cases after IV-ICG administration (5.8% versus 100%; p < 0.0001). (4) Conclusions: The present study demonstrates how ICG-fluorescence cholangiography can be helpful in identifying the extrahepatic biliary anatomy during dissection of Calot’s triangle in both administration methods. In comparison with intravenous ICG injection, the intracholecystic ICG route could provide a better signal-to-background ratio by avoiding hepatic fluorescence, thus increasing the bile duct-to-liver contrast.
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Affiliation(s)
- Lidia Castagneto-Gissey
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - Maria Francesca Russo
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - Alessandra Iodice
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - James Casella-Mariolo
- Department of General and Emergency Surgery, Ospedale dei Castelli (NOC), ASL Roma 6, 00040 Rome, Italy; (J.C.-M.); (A.S.)
| | - Angelo Serao
- Department of General and Emergency Surgery, Ospedale dei Castelli (NOC), ASL Roma 6, 00040 Rome, Italy; (J.C.-M.); (A.S.)
| | - Andrea Picchetto
- Department of General Surgery, Surgical Specialties and Organ Transplantation, Sapienza University of Rome, 00161 Rome, Italy; (A.P.); (G.D.)
| | - Giancarlo D’Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation, Sapienza University of Rome, 00161 Rome, Italy; (A.P.); (G.D.)
| | - Irene Urciuoli
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - Alessandro De Luca
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - Bruno Salvati
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - Giovanni Casella
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
- Correspondence: ; Tel.: +39-064-997-5515
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25
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Tseng C, Huang PW, Huang SW, Chen YC, Hung MC, Wong HP, Chou DA. Study of Learning Curve in a Surgeon for Near-Infrared Fluorescence Cholangiography During Laparoscopic Cholecystectomy-A Retrospective Evaluation. Surg Innov 2022; 29:519-525. [PMID: 35482941 DOI: 10.1177/15533506221093239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Chun Tseng
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ping-Wen Huang
- Department of Emergency Medicine, 63295Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Shih-Wei Huang
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan.,IRCAD/AITS-Asian Institute of TeleSurgery, Show Chwan Health Care System, Changhua, Taiwan
| | - Yi-Chun Chen
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Min-Chang Hung
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Hon Phin Wong
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan.,IRCAD/AITS-Asian Institute of TeleSurgery, Show Chwan Health Care System, Changhua, Taiwan
| | - Dev-Aur Chou
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan
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26
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Guía de uso e indicaciones de la fluorescencia con verde de indocianina (ICG) en cirugía general: recomendaciones basadas en la revisión descriptiva de la literatura y el análisis de la experiencia. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2021.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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27
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Serban D, Badiu D, Davitoiu D, Tanasescu C, Tudosie M, Sabau A, Dascalu A, Tudor C, Balasescu S, Socea B, Costea D, Zgura A, Costea A, Tribus L, Smarandache C. Systematic review of the role of indocyanine green near‑infrared fluorescence in safe laparoscopic cholecystectomy (Review). Exp Ther Med 2021; 23:187. [DOI: 10.3892/etm.2021.11110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dragos Serban
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dumitru Badiu
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dragos Davitoiu
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ciprian Tanasescu
- Third Clinical Department, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Mihail Tudosie
- Discipline of Clinical Toxicology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alexandru Sabau
- Third Clinical Department, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Ana Dascalu
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Corneliu Tudor
- Fourth Department of Surgery, Emergency University Hospital, 050098 Bucharest, Romania
| | - Simona Balasescu
- Fourth Department of Surgery, Emergency University Hospital, 050098 Bucharest, Romania
| | - Bogdan Socea
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniel Costea
- Department of Clinical Surgical Disciplines I, Faculty of Medicine, Ovidius University, 900527 Constanta, Romania
| | - Anca Zgura
- Department of Radiology, Oncology, and Hematology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020011 Bucharest, Romania
| | - Andreea Costea
- Department of Nephrology and Dialysis, ‘Diaverum’ Clinic, 900612 Constanta, Romania
| | - Laura Tribus
- Department of Internal Medicine Gastroenterology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020011 Bucharest, Romania
| | - Catalin Smarandache
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
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28
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Cárdenas G, Fornaguera I, Díaz Del Gobbo R, Ginestà C. Direct gallbladder indocyanine green injection technique to achieve critical view of safety in laparoscopic cholecystectomy. Cir Esp 2021; 99:678-682. [PMID: 34649822 DOI: 10.1016/j.cireng.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/26/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bile duct injury is one of the most severe complications after cholecystectomy. The aim of this study is to demonstrate how with a simple technique, an optimal critical view may be achieved by injecting indocyanine green directly into the gallbladder. METHODS Twenty-three patients were prospectively studied in which direct gallbladder injection of indocyanine green during laparoscopy was administered with a fine needle using an easily reproducible technique. RESULTS Biliary tree identification was reported before and after injection. Critical view of safety was achieved in all cases. CONCLUSIONS Our technique of direct gallbladder injection of indocyanine green is simple, efficient and shows a real time fluorescent cholangiography and an optimal critical view of safety decreasing the risk for bile duct injury.
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Affiliation(s)
- Gabriel Cárdenas
- Servicio de Cirugía General y Digestiva, Hospital HM Delfos, Barcelona, Spain.
| | - Ione Fornaguera
- Servicio de Cirugía General y Digestiva, Hospital HM Delfos, Barcelona, Spain
| | | | - César Ginestà
- Servicio de Cirugía General y Digestiva, Hospital HM Delfos, Barcelona, Spain
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29
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Pesce A, Piccolo G, Lecchi F, Fabbri N, Diana M, Feo CV. Fluorescent cholangiography: An up-to-date overview twelve years after the first clinical application. World J Gastroenterol 2021; 27:5989-6003. [PMID: 34629815 PMCID: PMC8476339 DOI: 10.3748/wjg.v27.i36.5989] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/10/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic cholecystectomy (LC) is one of the most frequently performed gastrointestinal surgeries worldwide. Bile duct injury (BDI) represents the most serious complication of LC, with an incidence of 0.3%-0.7%, resulting in significant perioperative morbidity and mortality, impaired quality of life, and high rates of subsequent medico-legal litigation. In most cases, the primary cause of BDI is the misinterpretation of biliary anatomy, leading to unexpected biliary lesions. Near-infrared fluorescent cholangiography is widely spreading in clinical practice to delineate biliary anatomy during LC in elective and emergency settings. The primary aim of this article was to perform an up-to-date overview of the evolution of this method 12 years after the first clinical application in 2009 and to highlight all advantages and current limitations according to the available scientific evidence.
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Affiliation(s)
- Antonio Pesce
- Department of Surgery, Section of General Surgery, Ospedale del Delta, Azienda USL of Ferrara, University of Ferrara, Ferrara 44023, Italy
| | - Gaetano Piccolo
- Department of Health Sciences, University of Milan, Unit of Hepato-Bilio-Pancreatic and Digestive Surgery, San Paolo Hospital, Milano 20142, Italy
| | - Francesca Lecchi
- Department of Health Sciences, University of Milan, Unit of Hepato-Bilio-Pancreatic and Digestive Surgery, San Paolo Hospital, Milano 20142, Italy
| | - Nicolò Fabbri
- Department of Surgery, Section of General Surgery, Ospedale del Delta, Azienda USL of Ferrara, University of Ferrara, Ferrara 44023, Italy
| | - Michele Diana
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, IRCAD, Research Institute Against Digestive Cancer, ICUBE lab, PHOTONICS for Health, University of Strasbourg, Strasbourg Cedex F-67091, France
| | - Carlo Vittorio Feo
- Department of Surgery, Section of General Surgery, Ospedale del Delta, Azienda USL of Ferrara, University of Ferrara, Ferrara 44023, Italy
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30
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Jin H, Yang J, Lu L, Cui M. Propensity score matching between conventional laparoscopic cholecystectomy and indocyanine green cholangiography-guided laparoscopic cholecystectomy: observational study. Lasers Med Sci 2021; 37:1351-1359. [PMID: 34398384 DOI: 10.1007/s10103-021-03401-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
The injury of common bile duct (CBD) is one of the most common complications during laparoscopic cholecystectomy. Consequences of CBD injury are grave since CBD is the only pathway of bile from biliary tracts to duodenum. When CBD injury occurs, extra surgical procedures repairing CBD or reconstructing biliary tracts have to be performed on patients, which increase expenses of patients and physical trauma. A total of 238 patients undergoing laparoscopic cholecystectomy (LC) in Zhuhai People's Hospital from July 2020 to April 2021 were enrolled in this observational study, including 126 patients undergoing conventional LC and 112 patients undergoing ICG angiography-guided LC. Method of propensity score matching was used to balance the preoperative data of patients in the two groups. For both groups, the "Critical View of Safety" (CVS) was introduced. For the ICG group, the CBD, cystic duct (CD), and gallbladder were identified using near-infrared (NIR) ray. Intraoperative blood loss, operation time, postoperative hospitalization time, and the incidence rate of intraoperative complications were compared between the two groups. ICG angiography in LC shows safe and effective outcomes. The intraoperative blood loss, operation duration, postoperative hospitalization time, and complication incidence rate of the ICG group are significantly lower than those of the conventional group. ICG angiography in LC was a useful and effective method to identify the CBD and prevent intraoperative complications. Registration at Chinese Clinical Trial Registry, No: ChiCTR1900024594. Registration time: 18/07/2019.
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Affiliation(s)
- Hao Jin
- The Second Department of General Surgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, 519000, Guangdong Province, China
| | - Jun Yang
- The Second Department of General Surgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, 519000, Guangdong Province, China
| | - Ligong Lu
- Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, 519000, Guangdong Province, China.
| | - Min Cui
- Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, 519000, Guangdong Province, China.
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31
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Shibata H, Aoki T, Koizumi T, Kusano T, Yamazaki T, Saito K, Hirai T, Tomioka K, Wada Y, Hakozaki T, Tashiro Y, Nogaki K, Yamada K, Matsuda K, Fujimori A, Enami Y, Murakami M. The Efficacy of Intraoperative Fluorescent Imaging Using Indocyanine Green for Cholangiography During Cholecystectomy and Hepatectomy. Clin Exp Gastroenterol 2021; 14:145-154. [PMID: 33958888 PMCID: PMC8096340 DOI: 10.2147/ceg.s275985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/06/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose Bile duct injury is one of the most serious complications of laparoscopic cholecystectomy. Intraoperative indocyanine green (ICG) cholangiography is a safe and useful navigation modality for confirming the biliary anatomy. ICG cholangiography is expected to be a routine method for helping avoid bile duct injuries. Patients and Methods We examined 25 patients who underwent intraoperative cholangiography using ICG fluorescence. Two methods of ICG injection are used: intrabiliary injection (percutaneous transhepatic gallbladder drainage [PTGBD], gallbladder [GB] puncture and endoscopic nasobiliary drainage [ENBD]) at a dosage of 0.025 mg during the operation or intravenous injection with 2.5 mg ICG preoperatively. Results There were 24 patients who underwent laparoscopic cholecystectomy and 1 patient who underwent hepatectomy. For laparoscopic cholecystectomy, the average operation time was 127 (50–197) minutes, and estimated blood loss was 43.2 (0–400) g. The ICG administration route was intravenous injections in 12 cases and intrabiliary injection in 12 cases (GB injection: 3 cases, PTGBD: 8 cases, ENBD:1 case). The course of the biliary tree was able to be confirmed in all cases that received direct injection into the biliary tract, whereas bile structures were recognizable in only 10 cases (83.3%) with intravenous injection. The postoperative hospital stay was 4.6 (3–9) days, and no postoperative complications (Clavien–Dindo ≧IIIa) were observed. For hepatectomy, a tumor located near the left Glissonian pedicle was resected using a fluorescence image guide. Biliary structures were fluorescent without injury after resecting the tumor. No adverse events due to ICG administration were observed, and the procedure was able to be performed safely. Conclusion ICG fluorescence imaging allows surgeons to visualize the course of the biliary tree in real time during cholecystectomy and hepatectomy. This is considered essential for hepatobiliary surgery to prevent biliary tree injury and ensure safe surgery.
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Affiliation(s)
- Hideki Shibata
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Takeshi Aoki
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Tomotake Koizumi
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Tomokazu Kusano
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Tatsuya Yamazaki
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Kazuhiko Saito
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Takahito Hirai
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Kodai Tomioka
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Yusuke Wada
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Tomoki Hakozaki
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Yoshihiko Tashiro
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Koji Nogaki
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Kosuke Yamada
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Kazuhiro Matsuda
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Akira Fujimori
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Yuta Enami
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Masahiko Murakami
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
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32
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Cárdenas G, Fornaguera I, Díaz Del Gobbo R, Ginestà C. Direct gallbladder Indocyanine Green injection technique to achieve critical view of safety in laparoscopic cholecystectomy. Cir Esp 2021; 99:S0009-739X(21)00027-0. [PMID: 33712221 DOI: 10.1016/j.ciresp.2020.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/10/2020] [Accepted: 12/26/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Bile duct injury is one of the most severe complications after cholecystectomy. The aim of this study is to demonstrate how with a simple technique, an optimal critical view may be achieved by injecting indocyanine green directly into the gallbladder. METHODS Twenty-three patients were prospectively studied in which direct gallbladder injection of indocyanine green during laparoscopy was administered with a fine needle using an easily reproducible technique. RESULTS Biliary tree identification was reported before and after injection. Critical view of safety was achieved in all cases. CONCLUSIONS Our technique of direct gallbladder injection of indocyanine green is simple, efficient and shows a real time fluorescent cholangiography and an optimal critical view of safety decreasing the risk for bile duct injury.
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Affiliation(s)
- Gabriel Cárdenas
- Servicio de Cirugía General y Digestiva, Hospital HM Delfos, Barcelona, España.
| | - Ione Fornaguera
- Servicio de Cirugía General y Digestiva, Hospital HM Delfos, Barcelona, España
| | | | - César Ginestà
- Servicio de Cirugía General y Digestiva, Hospital HM Delfos, Barcelona, España
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33
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Yong CC, Yin SM, Sng YP, Chen CL. Prevent bile duct injury by indocyanine green guide fluorescent imaging during laparoscopic cholecystectomy in liver transplantation recipient. Hepatobiliary Surg Nutr 2020; 9:817-819. [PMID: 33299845 DOI: 10.21037/hbsn-20-342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chee-Chien Yong
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Shih-Min Yin
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Yi-Ping Sng
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Chao-Long Chen
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
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34
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Lwin TM, Hoffman RM, Bouvet M. Fluorescence-guided hepatobiliary surgery with long and short wavelength fluorophores. Hepatobiliary Surg Nutr 2020; 9:615-639. [PMID: 33163512 DOI: 10.21037/hbsn.2019.09.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Fluorescence-guided surgery (FGS) is a potentially powerful tool for hepatobiliary (HPB) surgery. The high sensitivity of fluorescence navigation is especially useful in settings where tactile feedback is limited. Objective The present narrative review evaluates literature on the use of FDA-approved fluorophores such as methylene blue (MB), 5-aminolevulinic acid (5-ALA), and indocyanine green (ICG) for clinical intra-operative image-guidance during HPB surgery. Evidence Review Approaches such as dosing, timing, imaging devices and comparative endpoints are summarized. The feasibility and safety of fluorophores in visualizing the biliary tree, identify biliary leaks, outline anatomic hepatic segments, identify tumors, and evaluate perfusion and graft function in liver transplants are discussed. Findings Tumor-specific probes are a promising advancement in FGS with a greater degree of specificity. The current status of tumor-specific probes being evaluated in clinical trials are summarized. Conclusions and Relevance for Reviews Relevant discussion of promising tumor-specific probes in pre-clinical development are discussed. Fluorescence-guidance in HPB surgery is relatively new, but current literature shows that the dyes are reliably able to outline desired structures with a variety of dosing, timing, and imaging devices to provide real-time intra-operative anatomic information to surgeons. Development of tumor-specific probes will further advance the field of HPB surgery especially during oncologic resections.
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Affiliation(s)
- Thinzar M Lwin
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Robert M Hoffman
- Department of Surgery, University of California San Diego, San Diego, CA, USA.,AntiCancer, Inc., San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - Michael Bouvet
- Department of Surgery, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
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Agnus V, Pesce A, Boni L, Van Den Bos J, Morales-Conde S, Paganini AM, Quaresima S, Balla A, La Greca G, Plaudis H, Moretto G, Castagnola M, Santi C, Casali L, Tartamella L, Saadi A, Picchetto A, Arezzo A, Marescaux J, Diana M. Fluorescence-based cholangiography: preliminary results from the IHU-IRCAD-EAES EURO-FIGS registry. Surg Endosc 2020; 34:3888-3896. [PMID: 31591654 DOI: 10.1007/s00464-019-07157-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Near-infrared fluorescence cholangiography (NIRF-C) is a popular application of fluorescence image-guided surgery (FIGS). NIRF-C requires near-infrared optimized laparoscopes and the injection of a fluorophore, most frequently Indocyanine Green (ICG), to highlight the biliary anatomy. It is investigated as a tool to increase safety during cholecystectomy. The European registry on FIGS (EURO-FIGS: www.euro-figs.eu ) aims to obtain a snapshot of the current practices of FIGS across Europe. Data on NIRF-C are presented. METHODS EURO-FIGS is a secured online database which collects anonymized data on surgical procedures performed using FIGS. Data collected for NIRF-C include gender, age, Body Mass Index (BMI), pathology, NIR device, ICG dose, ICG timing of administration before intraoperative visualization, visualization (Y/N) of biliary structures such as the cystic duct (CD), the common bile duct (CBD), the CD-CBD junction, the common hepatic duct (CHD), Visualization scores, adverse reactions to ICG, operative time, and surgical complications. RESULTS Fifteen surgeons (12 European surgical centers) uploaded 314 cases of NIRF-C during cholecystectomy (cholelithiasis n = 249, cholecystitis n = 58, polyps n = 7), using 4 different NIR devices. ICG doses (mg/kg) varied largely (mean 0.28 ± 0.17, median 0.3, range: 0.02-0.62). Similarly, injection-to-visualization timing (minutes) varied largely (mean 217 ± 357; median 57), ranging from 1 min (direct intragallbladder injection in 2 cases) to 3120 min (n = 2 cases). Visualization scores before dissection were significantly correlated, at univariate analysis, with ICG timing (all structures), ICG dose (CD-CBD), device (CD and CD-CBD), surgeon (CD and CD-CBD), and pathology (CD and CD-CBD). BMI was not correlated. At multivariate analysis, pathology and timing remained significant factors affecting the visualization scores of all three structures, whereas ICG dose remained correlated with HD visualization only. CONCLUSIONS The EURO-FIGS registry has confirmed a wide disparity in ICG dose and timing in NIRF-C. EURO-FIGS can represent a valuable tool to promote and monitor FIGS-related educational and consensus activities in Europe.
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Affiliation(s)
- Vincent Agnus
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Antonio Pesce
- Department of Medical Surgical Sciences and Advanced Technologies "Ingrassia", Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Luigi Boni
- Department of Surgery, IRCCS - Ca' Granda - University Hospital of Milan, Milan, Italy
| | - Jacqueline Van Den Bos
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain
| | - Alessandro M Paganini
- Obesity and Minimally Invasive Surgery Division, Department of Cardiothoracic, Vascular Surgery, and Organ Transplantation, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Silvia Quaresima
- Obesity and Minimally Invasive Surgery Division, Department of Cardiothoracic, Vascular Surgery, and Organ Transplantation, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Andrea Balla
- Obesity and Minimally Invasive Surgery Division, Department of Cardiothoracic, Vascular Surgery, and Organ Transplantation, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gaetano La Greca
- Department of Medical Surgical Sciences and Advanced Technologies "Ingrassia", Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Haralds Plaudis
- Department of General and Emergency Surgery, Riga East Clinical University Hospital "Gailezers", Riga, Latvia
| | - Gianluigi Moretto
- Department of General Surgery, Ospedale Pederzoli, Peschiera del Garda, Verona, Italy
| | | | - Caterina Santi
- Azienda Unità Sanitaria Locale di Parma, Ospedale di Fidenza, Parma, Italy
| | - Lorenzo Casali
- Azienda Unità Sanitaria Locale di Parma, Ospedale di Fidenza, Parma, Italy
| | - Luciano Tartamella
- Azienda Unità Sanitaria Locale di Parma, Ospedale di Fidenza, Parma, Italy
| | - Alend Saadi
- Department of General Surgery, Hospital of Pourtalès, Neuchâtel, Switzerland
| | - Andrea Picchetto
- General and Colorectal Surgery Division, Department of Cardiothoracic, Vascular Surgery and Organ Transplantation, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, 1, Place de l'Hôpital, 67091, Strasbourg, France
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.
- Department of General Surgery, Hospital of Pourtalès, Neuchâtel, Switzerland.
- IRCAD, Research Institute Against Cancer of the Digestive System, 1, Place de l'Hôpital, 67091, Strasbourg, France.
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Simultaneous multipurpose fluorescence imaging with IRDye® 800BK during laparoscopic surgery. Surg Endosc 2020; 35:4840-4848. [PMID: 32860134 DOI: 10.1007/s00464-020-07931-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND IRDye® 800BK is a fluorophore, currently undergoing clinical translation, which has both biliary and renal clearance. To date, there is no description of a fluorophore, which can be simultaneously used for non-invasive, near-infrared fluorescence-based (NIRF) visualization of different structures and perfusion evaluation. The purpose of this study was to evaluate IRDye® 800BK for the simultaneous assessment of bowel perfusion, lymphography, ureter and bile duct delineation. METHODS Six pigs received a 0.15 mg/kg dye as a single bolus intravenous injection (IV). With the FLER (fluorescence-based enhanced reality) software, fluorescence intensity (FI) of 5 regions of interest (ROI) in an ischemic bowel loop was measured along with the time to reach the FI peak, and capillary lactate was measured from the same ROI, followed by the assessment of the ureters and bile ducts for a maximal duration of 180 min after dye administration. In 3 animals, the procedure was initiated via gastroscopic injection of a 0.6 mg (1 mg/mL) dye in the gastric submucosa followed by lymphography in a NIRF setting. RESULTS Excellent visualization of the ureters and bowel perfusion was obtained under NIRF imaging. Additionally, the bile duct and gastric lymph ducts and nodes were visualized. A positive correlation was found between the time to peak FI in the ischemic bowel loop and the corresponding capillary lactate levels (rho 0.59, p < 0.001). CONCLUSION In this study, we successfully demonstrated the simultaneous multipurpose IRDye® 800BK applicability during laparoscopic surgery. This fluorophore has the potential to become a powerful and versatile image-guided surgery tool.
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Gené Škrabec C, Pardo Aranda F, Espín F, Cremades M, Navinés J, Zárate A, Cugat E. Fluorescent cholangiography with direct injection of indocyanine green (ICG) into the gallbladder: a safety method to outline biliary anatomy. Langenbecks Arch Surg 2020; 405:827-832. [PMID: 32827267 DOI: 10.1007/s00423-020-01967-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Near infrared cholangiography (NIRC) with indocyanine green (ICG) directly injected into the gallbladder is a novel technique to outline biliary anatomy. The purpose of this article is to analyze the usefulness and feasibility of NIRC as a safety method during laparoscopic cholecystectomies. MATERIAL AND METHODS A case-controlled study comparing 20 patients undergoing laparoscopic cholecystectomies with NIRC with direct injection of ICG into the gallbladder to 20 consecutive standard cholecystectomies. Operative time, length of stay, complications, conversion rates, and biliary injury were analyzed. RESULTS Both groups were comparable in epidemiological characteristics. In the ICG group fluorescent visualization of the junction of the Hartmann pouch and the whole cystic duct was achieved in 16 (80%) patients. Median surgical time was 65 (50-76) and 55 (45-71) min for the ICG and the control group, respectively (p = 0.113). There were no postoperative complications and no biliary duct injuries in any of the groups, and a patient from both groups underwent conversion to open surgery. CONCLUSION NIRC with direct injection of ICG into the gallbladder is a feasible method that is not time-consuming; it does not require a different learning curve from standard laparoscopic cholecystectomies and has no major complications described so far.
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Affiliation(s)
- Clara Gené Škrabec
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Fernando Pardo Aranda
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Francisco Espín
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Manel Cremades
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jordi Navinés
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alba Zárate
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esteban Cugat
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department of General and Digestive Surgery, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
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Liu Y, Peng Y, Su S, Fang C, Qin S, Wang X, Xia X, Li B, He P. A meta-analysis of indocyanine green fluorescence image-guided laparoscopic cholecystectomy for benign gallbladder disease. Photodiagnosis Photodyn Ther 2020; 32:101948. [PMID: 32771612 DOI: 10.1016/j.pdpdt.2020.101948] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND This meta-analysis was conducted to evaluate the effectiveness and safety of indocyanine green fluorescence image-guided laparoscopic cholecystectomy for benign gallbladder disease. METHODS Clinical studies were retrieved from PubMed, Embase, Cochrane Library, Medline, and the Web of Science databases. Study-specific effect sizes and their 95 % confidence intervals (CIs) were combined to calculate the pooled values, using fixed-effects or random-effects models. RESULTS Eleven studies with combined total of 2221 patients were included. Compared to the control group, the indocyanine green fluorescence imaging-guided group experienced shorter operative time (standardized mean difference [SMD] = -0.30; 95 % CI = -0.45 - -0.15; P < 0.001), shorter biliary anatomy identification time (SMD = -2.34; 95 % CI = -2.58 - -2.10; P < 0.001), lower blood loss (SMD = -0.14; 95 % CI = -0.26 - -0.01; P = 0.035), higher success rate of biliary tract imaging (odds ratio [OR] = 2.37; 95 % CI = 1.09-5.12; P = 0.029), lower rate of conversion to open surgery (OR = 0.10; 95 % CI = 0.04 - 0.28; P < 0.001), shorter hospital stay (SMD = -0.23; 95 % CI = -0.39 - -0.06, P = 0.008), and lower biliary tract imaging costs (SMD = -247.88; 95 % CI, -274.31--221.45, P = 0.000). Postoperative complications did not differ between the groups. CONCLUSION This systematic review shows that indocyanine green fluorescence biliary tract imaging is a safe and feasible new way for biliary tract identification in laparoscopic cholecystectomy.
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Affiliation(s)
- Yu Liu
- Department of Hepatobiliary Surgery, People's Hospital of Leshan, Sichuan, Leshan, 614000, China
| | - Yisheng Peng
- Department of General Surgery(Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Song Su
- Department of General Surgery(Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Cheng Fang
- Department of General Surgery(Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Shu Qin
- Department of General Surgery(Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, China
| | - Xuewen Wang
- Department of Hepatobiliary Surgery, Zigong Fourth People's Hospital, Zigong 643000, China
| | - Xianming Xia
- Department of General Surgery(Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China; Academician(Expert)Workstation of Sichuan Province, Luzhou, 646000, China
| | - Bo Li
- Department of General Surgery(Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China; Academician(Expert)Workstation of Sichuan Province, Luzhou, 646000, China.
| | - Pan He
- Department of General Surgery(Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, China; Academician(Expert)Workstation of Sichuan Province, Luzhou, 646000, China.
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Namikawa T, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Nakayama T, Inoue K, Sato T, Kobayashi M, Hanazaki K. Evolution of photodynamic medicine based on fluorescence image-guided diagnosis using indocyanine green and 5-aminolevulinic acid. Surg Today 2020; 50:821-831. [PMID: 31346808 DOI: 10.1007/s00595-019-01851-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/21/2019] [Indexed: 02/05/2023]
Abstract
New diagnostic techniques based on photodynamic medicine, such as near-infrared fluorescence using indocyanine green (NIR-ICG) and 5-aminolevulinic acid-mediated photodynamic diagnosis (ALA-PDD), are aiding navigation tasks across various fields of surgery. Specifically, NIR-ICG is being used for the intraoperative identification of sentinel lymph nodes or blood vessels in organ resection and for blood flow evaluation in surgery. These ICG-fluorescent imaging techniques could provide an additional and potentially valuable way to identify vascular and lymphatic structures in surrounding tissue. 5-Aminolevulinic acid is a precursor of a photosensitizing substance with affinity for tumors; thus, diagnostic laparoscopy using ALA-PDD in combination should improve the accuracy of detecting peritoneal dissemination in patients with advanced gastric cancer. The ability to overlay fluorescent imaging with conventional color images in real time using ALA-PDD and NIR with ICG would be of immense benefit to surgeons, providing good visualization and detection of target lesions not seen with the naked eye. A multi-center clinical study examining the safety and efficacy of ALA-PDD during laparoscopic examination for patients with advanced gastric cancer is currently underway in the form of doctor-initiated trials, and further verification studies will be conducted. Such imaging capability could have broad potential across cancer and vascular surgery.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan.
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan.
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Taku Nakayama
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
- Department of Urology, Kochi Medical School, Kochi, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
- Department of Cardiovascular Control, Kochi Medical School, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
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Kurahashi S, Komatsu S, Matsumura T, Fukami Y, Arikawa T, Saito T, Osawa T, Uchino T, Kato S, Suzuki K, Toda Y, Kaneko K, Sano T. A novel classification of aberrant right hepatic ducts ensures a critical view of safety in laparoscopic cholecystectomy. Surg Endosc 2020; 34:2904-2910. [PMID: 32377838 DOI: 10.1007/s00464-020-07610-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Based on the spatial relationship of an aberrant right hepatic duct (ARHD) with the cystic duct and gallbladder neck, we propose a practical classification to evaluate the specific form predisposing to injury in laparoscopic cholecystectomy (LC). METHODS We retrospectively investigated the preoperative images (mostly magnetic resonance cholangiopancreatography) and clinical outcomes of 721 consecutive patients who underwent LC at our institute from 2015 to 2018. We defined the high-risk ARHD as follows: Type A: communicating with the cystic duct and Type B: running along the gallbladder neck or adjacent to the infundibulum (the minimal distance from the ARHD < 5 mm), regardless of the confluence pattern in the biliary tree. Other ARHDs were considered to be of low risk. RESULTS A high-risk ARHD was identified in 16 cases (2.2%): four (0.6%) with Type A anatomy and 12 (1.7%) with Type B. The remaining ARHD cases (n = 34, 4.7%) were categorized as low risk. There were no significant differences in the operative outcomes (operative time, blood loss, hospital stay) between the high- and low- risk groups. Subtotal cholecystectomy was applied in four cases (25%) in the high-risk group, a significantly higher percentage than the low-risk group (n = 1, 2.9%). In all patients with high-risk ARHD, LC was completed safely without bile duct injury or conversion to laparotomy. CONCLUSIONS Our simple classification of high-risk ARHD can highlight the variants located close to the dissecting site to achieve a critical view of safety and may contribute to avoiding inadvertent damage of an ARHD in LC.
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Affiliation(s)
- Shintaro Kurahashi
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shunichiro Komatsu
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Tatsuki Matsumura
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasuyuki Fukami
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Arikawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takuya Saito
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takaaki Osawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tairin Uchino
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shoko Kato
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenta Suzuki
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yoko Toda
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Sano
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Jao ML, Wang YY, Wong HP, Bachhav S, Liu KC. Intracholecystic administration of indocyanine green for fluorescent cholangiography during laparoscopic cholecystectomy-A two-case report. Int J Surg Case Rep 2020; 68:193-197. [PMID: 32172195 PMCID: PMC7075798 DOI: 10.1016/j.ijscr.2020.02.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/17/2022] Open
Abstract
It is difficult to visualize extra-hepatic biliary anatomy clearly because of long-presence of ICG in liver when administered intravenously. Intracholecystic ICG injection illuminates extra-hepatic biliary tree preferentially thus reducing background hepatic noise. Surgeons can experience more satisfaction with the use of fluorescent cholangiography during laparoscopic cholecystectomy when the intracystic route of ICG administration is utilized. Introduction The utility of intracystic administration of indocyanine green for near-infrared fluorescent cholangiography in acute calculous cholecystitis initially treated with percutaneous transhepatic gallbladder drainage (PTGBD) was described in this report. Presentation of case Two cases who underwent near-infrared fluorescent cholangiography guided interval laparoscopic cholecystectomy two weeks post-PTGBD were studied retrospectively. Both patients were diagnosed with moderate acute calculous cholecystitis based on diagnostic criteria of the Tokyo guidelines. Two routes of indocyanine green administration were utilized during surgery, first through direct intracystic administration through PTGBD tube (5 ml of 12.5 mg ICG) to achieve critical view of safety and then intravenous administration (1 ml of 2.5 mg ICG) to visualize cystic artery. Discussion Both patients had critical view of safety visualized clearly with ICG with the operation time of 84 and 125 min in cases 1 and 2, respectively without any intra or postoperative complications. Conclusion In comparison with intravenous ICG administration, trans-PTGBD ICG route can provide better signal-to-noise ratio by avoiding hepatic fluorescence and thus increasing the bile duct to liver contrast. However, ICG may enter the lymphatic system through necrotic and inflammatory gallbladder mucosa, of which lymph spillage during gallbladder dissection can obscure the fluorescent view.
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Affiliation(s)
- Man-Ling Jao
- Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yen-Yu Wang
- IRCAD/AITS-Asian Institute of TeleSurgery, Chang Bing Show Chwan Hospital, Changhua, Taiwan
| | - Hon Phin Wong
- Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan.
| | - Sayali Bachhav
- IRCAD/AITS-Asian Institute of TeleSurgery, Chang Bing Show Chwan Hospital, Changhua, Taiwan
| | - Kai-Che Liu
- IRCAD/AITS-Asian Institute of TeleSurgery, Chang Bing Show Chwan Hospital, Changhua, Taiwan
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Wu D, Xue D, Zhou J, Wang Y, Feng Z, Xu J, Lin H, Qian J, Cai X. Extrahepatic cholangiography in near-infrared II window with the clinically approved fluorescence agent indocyanine green: a promising imaging technology for intraoperative diagnosis. Theranostics 2020; 10:3636-3651. [PMID: 32206113 PMCID: PMC7069080 DOI: 10.7150/thno.41127] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/31/2020] [Indexed: 12/16/2022] Open
Abstract
Rationale: Biliary tract injury remains the most dreaded complication during laparoscopic cholecystectomy. New intraoperative guidance technologies, including near-infrared (NIR) fluorescence cholangiography with indocyanine green (ICG), are under comprehensive evaluation. Previous studies had shown the limitations of traditional NIR light (NIR-I, 700-900 nm) in visualizing the biliary tract structures in specific clinical situations. The aim of this study was to evaluate the feasibility of performing the extrahepatic cholangiography in the second NIR window (NIR-II, 900-1700 nm) and compare it to the conventional NIR-I imaging. Methods: The absorption and emission spectra, as well as fluorescence intensity and photostability of ICG-bile solution in the NIR-II window were recorded and measured. In vitro intralipid® phantom imaging was performed to evaluate tissue penetrating depth in NIR-I and NIR-II window. Different clinical scenarios were modeled by broadening the penetration distance or generating bile duct injuries, and bile duct visualization and lesion site diagnosis in the NIR-II window were evaluated and compared with NIR-I imaging. Results: The fluorescence spectrum of ICG-bile solution extends well into the NIR-II region, exhibiting intense emission value and excellent photostability sufficient for NIR-II biliary tract imaging. Extrahepatic cholangiography using ICG in the NIR-II window obviously reduced background signal and enhanced penetration depth, providing more structural information and improved visualization of the bile duct or lesion location in simulated clinical scenarios, outperforming the NIR-I window imaging. Conclusions: The conventional clinically approved agent ICG is an excellent fluorophore for NIR-II bile duct imaging. Fluorescence cholangiography with ICG in the NIR-II window could provide adequate visualization of the biliary tract structures with increased resolution and penetration depth and might be a valid option to increase the safety of cholecystectomy in difficult cases.
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Affiliation(s)
- Di Wu
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Dingwei Xue
- Department of Urology, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Jing Zhou
- State Key Laboratory of Modern Optical Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Yifan Wang
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Zhe Feng
- State Key Laboratory of Modern Optical Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Junjie Xu
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Hui Lin
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Jun Qian
- State Key Laboratory of Modern Optical Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
- Zhejiang Provincial Key Laboratory of Laparoscopic Technology, Hangzhou, 310016, China
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Abstract
A correct lymph node (LN) staging is essential in oncological surgery. Indocyanine green (ICG) near-infrared fluorescence (NIRF) guided sentinel lymph node (SLN) navigation is a relatively novel technique. The aim of this review is to analyze the impact of ICG-NIRF on identification of LN metastases of gastrointestinal tumors. The Scopus and PubMed/MEDLINE literature databases were searched and 20 studies were included. The ICG-NIRF navigation of LN has been shown to enable and improve LN detection in gastrointestinal tumors; however, the mean detection, sensitivity, accuracy and false negative rates show substantial variation. This could be due to both the heterogeneous techniques applied and to the low retention of ICG by lymph nodes. Fluorescence imaging to identify LN drainage is a promising tool to improve oncological outcomes. Nonetheless, the technique requires further development in terms of hardware, software and fluorophores, which are currently being investigated.
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Ambe PC, Plambeck J, Fernandez-Jesberg V, Zarras K. The role of indocyanine green fluoroscopy for intraoperative bile duct visualization during laparoscopic cholecystectomy: an observational cohort study in 70 patients. Patient Saf Surg 2019; 13:2. [PMID: 30651756 PMCID: PMC6330420 DOI: 10.1186/s13037-019-0182-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 12/31/2022] Open
Abstract
Background Bile duct injury is the most feared complication during laparoscopic cholecystectomy. Real-time intraoperative imaging using indocyanine green (ICG) might reduce the risk of bile duct injury by improving visualization of the biliary tree during laparoscopic cholecystectomy. We compared the outcomes of laparoscopic cholecystectomy in patients with and without real-time ICG. Methods A retrospective analysis of the data of patients undergoing laparoscopic cholecystectomy with and without ICG in a referral centre for minimally invasive surgery was performed. We hypothesized that laparoscopic cholecystectomy with real-time ICG enables a better identification of the biliary tree and thus increases surgical safety. The outcomes of laparoscopic cholecystectomy with and without ICG were compared using the duration of surgery, the rate of bile duct injury, the rate of conversion, complications and the length of stay. Results Seventy patients including 29 with and 41 without ICG underwent laparoscopic cholecystectomy within the period of investigation. The median duration of surgery was 53.0 vs. 54.0 min while the median length of stay was 2.0 d in the group with and without ICG respectively. The rate of conversion was 2.4% in the group without ICG, while no conversion was performed in the group with ICG. NO bile duct injury occurred in both groups. These differences were not statistically significant. Conclusion Laparoscopic cholecystectomy with real-time indocyanine green fluorescence cholangiography enables a better visualization and identification of biliary tree and therefore should be considered as a means of increasing the safety of laparoscopic cholecystectomy.
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Affiliation(s)
- Peter C Ambe
- 1Department of Visceral, Minimally Invasive and Oncologic Surgery, Marien Hospital Düsseldorf, Rochusstr. 2, 40479, Düsseldorf, Germany.,2Department of Medicine Faculty of health, Witten / Herdecke University, Witten, Germany
| | - Jens Plambeck
- 1Department of Visceral, Minimally Invasive and Oncologic Surgery, Marien Hospital Düsseldorf, Rochusstr. 2, 40479, Düsseldorf, Germany
| | - Victoria Fernandez-Jesberg
- 1Department of Visceral, Minimally Invasive and Oncologic Surgery, Marien Hospital Düsseldorf, Rochusstr. 2, 40479, Düsseldorf, Germany
| | - Konstantinos Zarras
- 1Department of Visceral, Minimally Invasive and Oncologic Surgery, Marien Hospital Düsseldorf, Rochusstr. 2, 40479, Düsseldorf, Germany
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45
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Rossi G, Tarasconi A, Baiocchi G, De' Angelis GL, Gaiani F, Di Mario F, Catena F, Dalla Valle R. Fluorescence guided surgery in liver tumors: applications and advantages. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:135-140. [PMID: 30561406 PMCID: PMC6502182 DOI: 10.23750/abm.v89i9-s.7974] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Indexed: 02/08/2023]
Abstract
The use of fluorescence-guided surgery for benign and malignant hepatobiliary (HPB) neoplasms has significantly increased and improved imaging methods creating new interesting perspectives. A major challenge in HPB surgery is performing radical resection with maximal preservation of the liver parenchyma and obtaining a low rate of complications. Despite the developments, visual inspection, palpation, and intraoperative ultrasound remain the most utilized tools during surgery today. In laparoscopic and robotic HPB surgery palpation is not possible. Fluorescence imaging enables identification of subcapsular liver tumors through accumulation of indocyanine green (ICG), after preoperative intravenous injection, in cancerous tissues of hepatocellular carcinoma and in noncancerous hepatic parenchyma, around intrahepatic cholangiocarcinoma and liver metastases, and it can also be used for visualizing extrahepatic bile duct anatomy and hepatic segmental borders, increasing the accuracy and the easiness of open and minimally invasive hepatectomy. (www.actabiomedica.it)
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Affiliation(s)
- Giorgio Rossi
- Acute Care and Trauma Surgery Department, Maggiore Hospital of Parma, University of Parma, Italy.
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46
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Safe laparoscopic cholecystectomy: A systematic review of bile duct injury prevention. Int J Surg 2018; 60:164-172. [PMID: 30439536 DOI: 10.1016/j.ijsu.2018.11.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/14/2018] [Accepted: 11/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Since the introduction of laparoscopic cholecystectomy (LC), a substantial increase in bile duct injury (BDI) incidence was noted. Multiple methods to prevent this complication have been developed and investigated. The most suitable method however is subject to debate. In this systematic review, the different modalities to aid in the safe performance of LC and prevent BDI are delineated. MATERIALS AND METHODS A systematic search for articles describing methods for the prevention of BDI in LC was conducted using EMBASE, Medline, Web of science, Cochrane CENTRAL and Google scholar databases from inception to 11 June 2018. RESULTS 90 studies were included in this systematic review. Overall, BDI preventive techniques can be categorized as dedicated surgical approaches (Critical View of Safety (CVS), fundus first, partial laparoscopic cholecystectomy), supporting imaging techniques (intraoperative radiologic cholangiography, intraoperative ultrasonography, fluorescence imaging) and others. Dedicated surgical approaches demonstrate promising results, yet limited research is provided. Intraoperative radiologic cholangiography and ultrasonography demonstrate beneficial effects in BDI prevention, however the available evidence is low. Fluorescence imaging is in its infancy, yet this technique is demonstrated to be feasible and larger trials are in preparation. CONCLUSION Given the low sample sizes and suboptimal study designs of the studies available, it is not possible to recommend a preferred method to prevent BDI. Surgeons should primarily focus on proper dissection techniques, of which CVS is most suitable. Additionally, recognition of hazardous circumstances and knowledge of alternative techniques is critical to complete surgery with minimal risk of injury to the patient.
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47
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Near-Infrared Fluorescence Lymph Node Navigation Using Indocyanine Green for Gastric Cancer Surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.7602/jmis.2018.21.3.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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48
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Baiocchi GL, Diana M, Boni L. Indocyanine green-based fluorescence imaging in visceral and hepatobiliary and pancreatic surgery: State of the art and future directions. World J Gastroenterol 2018; 24:2921-2930. [PMID: 30038461 PMCID: PMC6054946 DOI: 10.3748/wjg.v24.i27.2921] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/08/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
In recent years, the use of fluorescence-guided surgery (FGS) to treat benign and malignant visceral, hepatobiliary and pancreatic neoplasms has significantly increased. FGS relies on the fluorescence signal emitted by injected substances (fluorophores) after being illuminated by ad hoc laser sources to help guide the surgical procedure and provide the surgeon with real-time visualization of the fluorescent structures of interest that would be otherwise invisible. This review surveys and discusses the most common and emerging clinical applications of indocyanine green (ICG)-based fluorescence in visceral, hepatobiliary and pancreatic surgery. The analysis, findings, and discussion presented here rely on the authors' significant experience with this technique in their medical institutions, an up-to-date review of the most relevant articles published on this topic between 2014 and 2018, and lengthy discussions with key opinion leaders in the field during recent conferences and congresses. For each application, the benefits and limitations of this technique, as well as applicable future directions, are described. The imaging of fluorescence emitted by ICG is a simple, fast, relatively inexpensive, and harmless tool with numerous different applications in surgery for both neoplasms and benign pathologies of the visceral and hepatobiliary systems. The ever-increasing availability of visual systems that can utilize this tool will transform some of these applications into the standard of care in the near future. Further studies are needed to evaluate the strengths and weaknesses of each application of ICG-based fluorescence imaging in abdominal surgery.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25125, Italy
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg 67000, France
- IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg 67000, France
| | - Luigi Boni
- General and Emergency Surgery, IRCCS - Ca’ Granda - Policlinico Hospital, Milan 20122, Italy
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49
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van Manen L, Handgraaf HJM, Diana M, Dijkstra J, Ishizawa T, Vahrmeijer AL, Mieog JSD. A practical guide for the use of indocyanine green and methylene blue in fluorescence-guided abdominal surgery. J Surg Oncol 2018; 118:283-300. [PMID: 29938401 PMCID: PMC6175214 DOI: 10.1002/jso.25105] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/21/2018] [Indexed: 12/14/2022]
Abstract
Near-infrared (NIR) fluorescence imaging is gaining clinical acceptance over the last years and has been used for detection of lymph nodes, several tumor types, vital structures and tissue perfusion. This review focuses on NIR fluorescence imaging with indocyanine green and methylene blue for different clinical applications in abdominal surgery with an emphasis on oncology, based on a systematic literature search. Furthermore, practical information on doses, injection times, and intraoperative use are provided.
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Affiliation(s)
- Labrinus van Manen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France.,Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Takeaki Ishizawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Jan Sven David Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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50
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Image-guided video-assisted thoracoscopic small lung tumor resection using near-infrared marking. Surg Endosc 2018; 32:4673-4680. [PMID: 29869081 DOI: 10.1007/s00464-018-6252-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/29/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Localization of non-visible, non-palpable small pulmonary nodules during video-assisted thoracoscopic surgery (VATS) remains challenging. We sought to investigate the feasibility and safety of image-guided video-assisted thoracoscopic surgery (iVATS) with near-infrared (NIR) marking in a hybrid operating room (OR). METHODS Both localization and surgery were performed by a single team of thoracic surgeons. Diluted indocyanine green (ICG; quantity: 0.3-0.5 mL; dye concentration: 0.125 mg/mL) was injected percutaneously to pinpoint the tumor's location under cone beam computed tomography (CBCT) guidance using a laser-guided navigation system. Real-time fluorescence images were intraoperatively obtained using a NIR thoracoscopic camera to guide subsequent resection. RESULTS Between March and December 2017, 26 patients underwent NIR marking of small pulmonary nodules for iVATS. The median tumor size was 7 mm (interquartile range [IQR] 5.3-10.8 mm), whereas their median distance from the pleural surface was 5 mm (IQR 0.3-10.5 mm). Seven nodules (35%) were solid, whereas 17 (65%) were ground-glass opacities. All lesions were identifiable on intraoperative CBCT. The median time required for NIR localization was 13 min. An NIR(+) "tattoo" was identified in all cases, and no intraoperative conversion to thoracotomy occurred. The final pathological diagnoses were primary lung cancer (n = 11), metastatic cancer (n = 6), and benign lung tumor (n = 9). Adverse events were not observed, and the median length of post-operative stay was 4 days (IQR 3-4 days). CONCLUSIONS Our data show that iVATS with NIR marking is useful, has no adverse effects, and can successfully localize difficult-to-identify small pulmonary nodules.
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