Micro-Dosing of Indocyanine Green for Intraoperative Fluorescence Cholangiography

2021 ◽  
Author(s):  
Jorge Rodriguez ◽  
Chet Hammill
Keyword(s):  
Indocyanine Green ◽  
Intraoperative Imaging ◽  
Optimal Dose ◽  
Biliary Tree ◽  
Proof Of Concept ◽  
Dye Uptake ◽  
Common Bile Duct Injury ◽  
Biliary Surgery ◽  
Video Library ◽  
Intraoperative Fluorescence

Background: Surgery involving the biliary tree is common but has the potential for serious complications. Adjuncts such as intraoperative cholangiogram and, more recently, indocyanine green (ICG) fluorescence cholangiography, have been used to more accurately define the relevant anatomy and decrease the risk of common bile duct injury. The optimal ICG dose is unknown, but the most commonly cited dose in the literature is 2.5 mg. We describe our experience using micro-dosing of ICG as proof-of-concept for its successful use in the identification of biliary structures. Methods: A video library from a variety of hepatobiliary surgeries which included micro-dosing of ICG was compiled between 2018 and 2020. These videos were retrospectively reviewed and graded for the degree of visualization of biliary structures (complete, partial, none) and the degree of background liver fluorescence (significant, moderate, minimal). Results: Overall, 40 videos were reviewed; 70% were minimally invasive cholecystectomies. Micro-dosing was used in all patients; complete visualization was achieved in 52.5% of the patients, partial visualization in 40%, and no visualization in 7.6%. Eighty percent of patients had minimal to moderate background fluorescence. Despite ICG micro-dosing, 20% of the patients still had significant liver dye uptake. Conclusion: ICG cholangiography is an alternative to more invasive means of intraoperative imaging during biliary surgery, but the optimal dose of ICG is unknown. We have used a 0.05 mg micro-dose of ICG to successfully visualize biliary structures and reduce background liver fluorescence. This preliminary report can be used to develop further studies into whether micro-dosing of ICG is associated with improved clinical outcomes.

scholarly journals Use of indocyanine green fluorescence during hepatobiliary surgery

2020 ◽  
Vol 9 (2) ◽  
pp. 74-80
Author(s):  
Dhiresh Kumar Maharjan ◽  
Prabin Bikram Thapa
Keyword(s):  
Indocyanine Green ◽  
Liver Tumors ◽  
Open Cholecystectomy ◽  
Biliary Tree ◽  
Hepatobiliary Surgery ◽  
Green Fluorescence ◽  
Biliary Anatomy ◽  
Biliary Surgery ◽  
Cross Sectional ◽  
Indocyanine Green Fluorescence

Background: Indocyanine green fluorescence image has been used in hepatobiliary surgery, which was mainly started by Japanese surgeons to visualize hepatobiliary structures probably because it is regarded as a reagent for estimation of hepatic function. Objectives: The objective of this study is to see the feasibility of use of indocyanine green in our setting during hepatobiliary surgery and its potential applications in the surgical treatment of benign and malignant liver pathology along with its selective use during difficult cholecystectomy to visualize extrahepatic biliary radical.  Methodology: This is a prospective cross sectional observational study performed including all   consecutive patients who were posted for liver resection, both benign or malignant and selectively used in biliary surgery when biliary anatomy was uncertain.    Results: A total of thirty-nine patients had usage of indocyanine green, with a mean age of 51.6 ± 11.6 years (range, 31-75 years). In all our patients we were able to visualize the biliary system and liver parenchymal lesion.In the selective use of indocyanine green during difficult biliary anatomy during laparoscopic cholecystectomy 15/400 (3.75%), we were able to delineate biliary tree and hence five patients (1.2%) had to be converted to open cholecystectomy further preventing injury to the bile duct. Conclusion: Indocyanine green fluorescence imaging can be used safely and easily to identify liver tumors, hepatic segments, and extrahepatic bile ducts in real time during open and minimally invasive surgery. This allows surgeons to map the anatomical variations, status of resection margin and prevent surgical complications.

Indocyanine green-augmented diode laser therapy of telangiectatic and reticular leg veins: a clinical proof-of-concept trial

2012 ◽  
Vol 25 (01) ◽  
Author(s):  
A Klein ◽  
G Shafirstein ◽  
E Kohl ◽  
W Bäumler ◽  
M Landthaler ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Laser Therapy ◽  
Diode Laser ◽  
Proof Of Concept

scholarly journals Extrahepatic biliary tract visualization using near-infrared fluorescence imaging with indocyanine green: optimization of dose and dosing time

2020 ◽  
Author(s):  
Qiangxing Chen ◽  
Rou Zhou ◽  
Jiefeng Weng ◽  
Yueyuan Lai ◽  
Hui Liu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Bile Duct ◽  
Indocyanine Green ◽  
Near Infrared ◽  
Controlled Trial ◽  
Optimal Dose ◽  
Imaging Data ◽  
Time Points ◽  
Optimal Dosing ◽  
Real Time Identification

Abstract Background The dose and dosing time of indocyanine green (ICG) vary among fluorescence cholangiography (FC) studies. The purpose of this prospective, randomized, exploratory clinical trial was to optimize the dose and dosing time of ICG. Methods PubMed was searched to determine the optimal dose. To optimize the dosing time of ICG, a clinical trial was designed with two parts. The first part included patients with T tubes for more than 1 month. After the patient was injected with ICG, bile was collected at 10 time points to explore the change and trends of bile fluorescence intensity (FI). In addition, the results of the first experiment were used to setup a randomized controlled trial (RCT) that aimed to find the optimal dosing timing for ICG injections for laparoscopic cholecystectomy (LC). During surgery, imaging data were collected for analysis. Results After performing a systematic review, the ICG injection dose for each patient in the clinical trial was 10 mg. Five patients were included in the first part of the study. Bile collected 8 h after ICG injection had a higher FI than bile collected at other time points (p < 0.05), and the FI of bile collected 20 h after ICG injection was nearly zero. In the second part of the experiment, 4 groups of patients (6 patients per group) were injected with 10 mg ICG at 8, 10, 12 and 14 h prior to surgery. The distribution of bile duct FI (p = 0.001), liver FI (p < 0.001), and common bile duct (CBD)-to-liver contrast (p = 0.001) were not the same in each group. Further analysis with the Bonferroni method revealed the following: (1) the FI of the CBD in the 8 h group was significantly different from that in the 14 h group (adjusted p < 0.001); (2) the liver FI of the 8 h group was higher than that of the 10 h group (adjusted p = 0.042) and the 14 h group (adjusted p < 0.001); and (3) the CBD-to-liver contrast of the 8 h group was lower than that of the 10 h group (adjusted p = 0.013) and the 14 h group (adjusted p = 0.001). Conclusion ICG FC enables the real-time identification of extrahepatic bile ducts. The optimal effect of FC can be achieved by performing 10 mg ICG injections 10 to 12 h prior to surgery.

Indocyanine green-augmented diode laser therapy of telangiectatic leg veins: A randomized controlled proof-of-concept trial

2012 ◽  
Vol 44 (5) ◽  
pp. 369-376 ◽  
Author(s):  
Annette Klein ◽  
Wolfgang Bäumler ◽  
Michael Koller ◽  
Gal Shafirstein ◽  
Elisabeth A. Kohl ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Laser Therapy ◽  
Diode Laser ◽  
Proof Of Concept ◽  
Randomized Controlled

Pilot study using intraoperative fluorescence angiography during arteriovenous hemodialysis access surgery

2018 ◽  
Vol 20 (2) ◽  
pp. 175-183
Author(s):  
Susanne Regus ◽  
Felix Klingler ◽  
Werner Lang ◽  
Alexander Meyer ◽  
Veronika Almási-Sperling ◽  
...  
Keyword(s):  
Pilot Study ◽  
Indocyanine Green ◽  
Arteriovenous Fistula ◽  
Fluorescence Angiography ◽  
Hemodialysis Access ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Access Surgery ◽  
Indocyanine Green Fluorescence Angiography ◽  
Intraoperative Fluorescence

Introduction: In this pilot study, we used indocyanine green fluorescence angiography during hemodialysis access surgery. The aim was to evaluate its relevance as a diagnostic tool to visualize changes in hand microperfusion. Patients and methods: In this prospective single-center study, 47 adult patients (33 male, 14 female) with renal disease (24 preemptive, 23 endstage) were enrolled. Surgical creation of an arteriovenous fistula was performed (22 forearm, 25 upper arm). Microperfusion of the ipsilateral hand and fingers was evaluated intraoperatively using indocyanine green fluorescence angiography. We compared the cumulated microperfusion parameters ingress (In) and ingress rate (InR) before and after opening of the anastomosis. To compare the dimension of microcirculatory decline, we calculated the ratios of the parameters (RatioIn and RatioInR) after to those before anastomosis opening. Results: The cumulated microperfusion parameters In and InR showed a significant decrease after completion of anastomosis and declamping. This effect has been seen in all patients for the hand and for each finger consecutively. During follow-up (mean 4.6, range 3–11 months), 5 patients (10.6%) complained about hemodialysis access–induced distal ischemia. The ratio of intraoperative microperfusion in those five hemodialysis access–induced ischemia patients was significantly lower compared to asymptomatic patients (RatioIn 0.23 vs 0.58, p = 0.001, and RatioInR 0.25 vs 0.62, p = 0.003). Conclusion: Intraoperative fluorescence angiography could visualize the deterioration of ipsilateral hand microperfusion after surgical creation of an arteriovenous fistula. It seems to be a promising tool to detect patients at risk for hemodialysis access–induced distal ischemia early in the peri- or even intraoperative stage.

scholarly journals Intraoperative Imaging of Pancreas Transplant Allografts Using Indocyanine Green with Laser Fluorescence

2008 ◽  
Vol 21 (3) ◽  
pp. 258-260 ◽  
Author(s):  
Edmund Q. Sanchez ◽  
Srinath Chinnakotla ◽  
Tariq Khan ◽  
Dmitriy Nikitin ◽  
Sugam Vasani ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Intraoperative Imaging ◽  
Laser Fluorescence ◽  
Pancreas Transplant
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