Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2024; 16(12): 3703-3709
Published online Dec 27, 2024. doi: 10.4240/wjgs.v16.i12.3703
Efficacy of multi-color near-infrared fluorescence with indocyanine green: A new imaging strategy and its early experience in laparoscopic cholecystectomy
Jia-Yi Li, Lu Ping, Bo-Zheng Lin, Zhi-Hong Wang, Chi-Hua Fang, Su-Rong Hua, Xian-Lin Han
Jia-Yi Li, Lu Ping, Bo-Zheng Lin, Su-Rong Hua, Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
Zhi-Hong Wang, Department of Neurosurgery/Neuro-Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong Province, China
Chi-Hua Fang, Department of Hepatobiliary Surgery, Zhujiang Hospital Southern Medical University, Guangzhou 510280, Guangdong Province, China
Xian-Lin Han, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
Co-first authors: Jia-Yi Li and Lu Ping.
Co-corresponding authors: Su-Rong Hua and Xian-Lin Han.
Author contributions: Hua SR, Han XL, and Li JY conceived the idea and design of the study; Han XL provided expert guidance of the study; Li JY, Ping L, Lin BZ, and Hua SR wrote the first manuscript draft; Li JY, Ping L, and Lin BZ generated the tables and figures; Li JY, Ping L, Lin BZ, Wang ZH, Fang CH, Hua SR and Han XL participated in revising the manuscript before submission and the formal revision, including literature searching, information extracting, and text modification; The corresponding authors attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Supported by the National High Level Hospital Clinical Research Funding, No. 2022-PUMCH-B-003; and Beijing Technology Innovation Foundation for University or College Students, No. 2022zglc06062.
Institutional review board statement: This study was performed in line with the principles of the Declaration of Helsinki and approval was granted by the Institutional Review Board of Peking Union Medical College Hospital, No. K5195.
Informed consent statement: Signed informed consent was waived from all participants.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Su-Rong Hua, MD, Doctor, Department of General Surgery, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. huasurong@tsinghua.org.cn
Received: May 19, 2024
Revised: September 20, 2024
Accepted: October 25, 2024
Published online: December 27, 2024
Processing time: 192 Days and 3 Hours
Abstract
BACKGROUND

Near-infrared fluorescence imaging via using intravenous indocyanine green (ICG) has a wide range of applications in multiple surgical scenarios. In laparoscopic cholecystectomy (LC), it facilitates intraoperative identification of the biliary system and reduces the risk of bile duct injury. However, the usual single color fluorescence imaging (SCFI) has limitations in manifesting the fluorescence signal of the target structure when its intensity is relatively low. Moreover, surgeons often experience visual fatigue. We hypothesized that a novel imaging strategy, named multi-color fluorescence imaging (MCFI), could potentially address these issues by decreasing hepatic and background fluorescence pollution and improving biliary visualization.

AIM

To investigate the novel imaging strategy MCFI in LC.

METHODS

This was a single-center retrospective study conducted at Peking Union Medical College Hospital, Beijing, China. Patients who underwent LC from June 2022 to March 2023 by the same surgical team were enrolled. Demographic features, clinical and surgical information were collected. The clarity, visual comfort, and effectiveness of different imaging strategies were subjectively evaluated by surgeons.

RESULTS

A total of 155 patients were included, 60 patients were in the non-ICG group in which only bright light illuminance without ICG was applied, 60 patients were in the SCFI group, and 35 patients were in the MCFI group. No statistically significant differences were found in demographics or clinical history. Post-surgical complications were minimal in all 3 groups with no significant differences observed. MCFI improved the clarity of imaging and visual comfort. Clarity of imaging and visual comfort were improved with MCFI.

CONCLUSION

MCFI improves biliary visualization and reduces liver fluorescence contamination, which supports its routine use in LC. MCFI may also be a better choice than SCFI in other clinical settings.

Keywords: Indocyanine green; Near-infrared fluorescence; Fluorescence imaging; Multi-color fluorescence imaging; Laparoscopic cholecystectomy

Core Tip: Near-infrared fluorescence imaging using intravenous indocyanine green facilitates intraoperative identification of biliary anatomy. However, the conventional single color strategy has limited distinguishable differences and the scale range of the fluorescence intensity; and the green fluorescence could cause visual fatigue on a reddish surgical background. Therefore, we aim to develop a novel multi-color fluorescence imaging strategy to correlate the fluorescence intensity. To help alleviate visual fatigue and observe structures with extreme low fluorescence intensity, we utilized a color range of blue to purple, and performed primary clinical trials in a large Chinese gallbladder disease center.