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

2021 ◽  
pp. 155335062110527
Author(s):  
Cristiana Iacuzzo ◽  
Livia Bressan ◽  
Marina Troian ◽  
Paola Germani ◽  
Fabiola Giudici ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Near Infrared ◽  
Intraoperative Complications ◽  
Major Complication ◽  
Added Value ◽  
Recorded Data ◽  
Elective Laparoscopic Cholecystectomy ◽  
Surgery Department ◽  
Near Infrared Fluorescence Imaging ◽  
White Light Imaging

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

scholarly journals Fluorescent Imaging With Indocyanine Green During Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury

2017 ◽  
Vol 24 (3) ◽  
pp. 245-252 ◽  
Author(s):  
Marjolein Ankersmit ◽  
Dieuwertje A. van Dam ◽  
Anne-Sophie van Rijswijk ◽  
Baukje van den Heuvel ◽  
Jurriaan B. Tuynman ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Indocyanine Green ◽  
Bile Duct Injury ◽  
Near Infrared ◽  
Fluorescent Imaging ◽  
Added Value ◽  
Optimal Dosage ◽  
Nir Light ◽  
Increased Risk

Background. Although rare, injury to the common bile duct (CBD) during laparoscopic cholecystectomy (LC) can be reduced by better intraoperative visualization of the cystic duct (CD) and CBD. The aim of this study was to establish the efficacy of early visualization of the CD and the added value of CBD identification, using near-infrared (NIR) light and the fluorescent agent indocyanine green (ICG), in patients at increased risk of bile duct injury. Materials and Methods. Patients diagnosed with complicated cholecystitis and scheduled for LC were included. The CBD and CD were visualized with NIR light before and during dissection of the liver hilus and at critical view of safety (CVS). Results. Of the 20 patients originally included, 2 were later excluded due to conversion. In 6 of 18 patients, the CD was visualized early during dissection and prior to imaging with conventional white light. The CBD was additionally visualized with ICG-NIR in 7 of 18 patients. In 1 patient, conversion was prevented due to detection of the CD and CBD with ICG-NIR. Conclusions. Early visualization of the CD or additional identification of the CBD using ICG-NIR in patients with complicated cholecystolithiasis can be helpful in preventing CBD injury. Future studies should attempt to establish the optimal dosage and time frame for ICG administration and bile duct visualization with respect to different gallbladder pathologies.

scholarly journals Response to: “timing of administration of indocyanine green for fluorescence-guided surgery in pancreatic cancer: response to Shirakawa et al.”

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sachiyo Shirakawa ◽  
Hirochika Toyama ◽  
Masahiro Kido ◽  
Takumi Fukumoto
Keyword(s):  
Pancreatic Cancer ◽  
Indocyanine Green ◽  
Hepatic Metastasis ◽  
Peritoneal Metastasis ◽  
Near Infrared ◽  
Staging Laparoscopy ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
Near Infrared Fluorescence Imaging ◽  
White Light Imaging

Abstract This is the response article to correspondence article received for our published article in BMC surgery titled “A prospective single-center protocol for using near-infrared fluorescence imaging with indocyanine green during staging laparoscopy to detect small metastasis from pancreatic cancer”. Peter L. Labib, MBChB pointed out the necessity to administer indocyanine green intravenously in separate timing for detection of metastasis in liver and peritoneum. Preoperative injection is suitable to detect hepatic metastasis and intraoperative injection is reported to be well suited to detect peritoneal metastasis. However, we could not find the usefulness of intraoperative injection of indocyanine green for detecting peritoneal metastasis in cases with staging laparoscopy prior to this study. We employed this study protocol with only preoperative injection of indocyanine green to simplify the procedure with consideration of probably more frequent cases of hepatic metastasis that is difficult to detect with white-light imaging than those of peritoneal metastasis.

scholarly journals Near-infrared fluorescent cholangiography – real-time visualization of the biliary tree during elective laparoscopic cholecystectomy

HPB ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 538-545 ◽  
Author(s):  
Antonio Pesce ◽  
Saverio Latteri ◽  
Martina Barchitta ◽  
Teresa R. Portale ◽  
Biagio Di Stefano ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Real Time ◽  
Near Infrared ◽  
Biliary Tree ◽  
Fluorescent Cholangiography ◽  
Real Time Visualization ◽  
Elective Laparoscopic Cholecystectomy

scholarly journals Difficult Laparoscopic Cholecystectomy

2019 ◽  
Vol 11 (9) ◽  
pp. 102
Author(s):  
Mohammed Alabed Alhamid
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Professional Competence ◽  
Intraoperative Complications ◽  
Open Cholecystectomy ◽  
Major Complication ◽  
Anatomical Variations ◽  
Laparoscopic Technique ◽  
Transformation Rate ◽  
Wise Decision ◽  
History Of

Laparoscopic cholecystectomy is as much easy procedure as difficult one. Surgeon should consider every case as his first one. Intraoperative complications are common while transformation to open surgery should be always in consideration. Transformation to open cholecystectomy isn't a sign of lack of experience, rather it is a proof of surgeon cleverness and an evidence of professional competence as it could keep our patient away from life-threatening complications in difficult situations. Predictive factors for difficulty vary from male patient, repeated acute attacks, history of obstructive jaundice, presence of abnormal anatomical or pathological findings, and adhesions. The aim of this study was to assess some preoperative causes namely by history, clinical examination and, radiological data which can dependably anticipate the odds of troublesome laparoscopic Cholecystectomy or alteration to open Cholecystectomy .1005 patients experienced laparoscopic cholecystectomy 171 of them were difficult cases (10.05%). Transformation rate in our study is within the lower limits and accepted internationally. Dense fibrous adhesion and bleeding are the main causes of transformation. History of acute cholecystitis is separate hazard factor for transformation from laparoscopic to open procedure. Gender and age are also showing increasing rate of transformation. Results shown bile duct damages may evaded even with nearness of hazard factors as anatomical variations from the of biliary channels, intense cholecystitis, extreme endless fibrosis, affected stones inside Hartmann pocket, and short cystic pipe during laparoscopic cholecystectomy by careful watching and wise decision of transformation whenever surgeon feels risk of major complication in case of proceeding in laparoscopic technique. Mortality not encountered directly through the procedure or in short post-operative period but as sequel of complicated cases. Authors proposes that change of the laparoscopic cholecystectomy isn't really a disappointment of the specialist, as usually explained, yet is a lifesaving method as delineated by the results of the study. The experience of the operating surgeon assumes an essential function on this subject.

scholarly journals P11: NEAR INFRARED FLUORESCENT CHOLANGIOGRAPHY IN LAPAROSCOPIC CHOLECYSTECTOMY: A SINGLE CENTRE FEASIBILITY STUDY. THE OPTIMUM DOSING REGIME, LIMITATIONS AND WHERE NEXT?

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
G Armstrong ◽  
G Toogood ◽  
DG Jayne ◽  
AM Smith
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Indocyanine Green ◽  
Feasibility Study ◽  
Near Infrared ◽  
Intravenous Dose ◽  
Structure Identification ◽  
Dosing Regimen ◽  
Single Centre ◽  
Fluorescent Cholangiography

Abstract Introduction This study explored near-infrared fluorescent cholangiography (NIRFC) with Indocyanine Green (ICG) during laparoscopic cholecystectomy (LC) surgery in a tertiary referral hepatobiliary unit. ICG binds to albumin and is excreted in bile. NIRFC utilises the fluorescent and excretory properties of ICG to provide dynamic extrahepatic bile duct mapping during LC. Method Non-randomised single centre feasibility study. Twenty-two participants were sequentially allocated to four dosing subgroups prior to NIRFC assisted LC. Each received a single intravenous dose of ICG prior to LC with the Stryker Novadaq NIR laparoscope. The biliary anatomy was assessed with NIRFC at three time-points, detection was compared to radiological cholangiogram where available and surgeon satisfaction was assessed. Result Eight participants received 2.5mg ICG 20-40min before surgery, four 0.25mg/kg 20-40min, five 90min – 180min and five 12 – 36 hour pre-operatively. Average age 50 years (S.D±15), BMI 27.5m2 (S.D±3.6), 6/22 were acute LC procedures. The prolonged dosing interval produced increased extrahepatic biliary structure identification (p = 0.016), reduced noise to signal ratio and was consistently preferred by the operating surgeon. NIRFC was inferior to radiological cholangiogram (n = 10) (p = 0.014) for bile duct mapping. We observed iatrogenic bile spillage saturating the field and obscuring structure differentiation and peri-hilar inflammation impeding fluorescent detection in acute LC. Conclusion The dosing regimen 0.25mg/kg ICG 12 to 36 hours prior to surgery provides optimum NIRFC structure visualisation. Fluorescent tissue penetrance is limited in acute peri-hilar inflammation. More research in to the efficiency of NIRFC in emergency LC is required. Take-home message An intravenous dose of 0.25mg/kg of Indocyanine Green 12 to 36 hours before surgery is the optimum dosing regimen for increased extra-hepatic bile duct structures with near infrared fluorescent cholangiography. The role of NIRFC in acute laparoscopic cholecystectomy surgery remains ill-defined.

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