ICG fluorescence imaging of biliary anatomy during laparoscopic cholecystectomy

N Tagaya, PhD, T Tatsuoka, Y Kubota, M Takagami, A Suzuki, K Saito, Y Yamagata, T Okuyama, S Koketsu, Y Sugamata, S Sameshima, M Oya. Department of Surgey, Dokkyo Medical University Koshigaya Hospital

Introduction: Bile duct injury (BDI) is a common problem during cholecystectomy with an estimated occurrence rate of 0.1-1.5 %. To prevent or minimize BDI, we have introduced into clinical practice of fluorescence imaging with indocyanine green, and evaluate our outcomes during laparoscopic cholecystectomy.

Patients and Methods: During last 4 years we performed ICG fluorescence imaging in 25 patients. They included 10 males and 15 females with a mean age of 57 years and a body mass index of 24.5 kg/m2. ICG was administered intravenously one hour before surgery. We observed the biliary tract using a laparoscope with infrared function, and the cystic artery was also observed after re-injection of ICG. Cholecystectomy was done by an ordinary manner.

Results: There were no additional ports or conversion to open cholecystectomy. The mean operation time was 83 min. We identified the biliary tract using fluorescence imaging in all patients, and the cystic artery was recognized approximately 10 seconds after re-injection of ICG. There were no specific perioperative complications related to the intravenous injection of ICG. The median postoperative hospital stay was 3 days.

Conclusion: Intraoperative exploration of the biliary anatomy using ICG is a useful and safe navigation modality that does not require cannulation into the cystic duct, arrangement of X-ray equipment or use of radioactive materials. This technique will become routine, offering a lower degree of invasiveness that will help to avoid or minimize injury to the bile duct and vessels.

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