Jenny Lam, MD, Toshiaki Suzuki, MD, Carlos T Maeda, MD, David Bernstein, MD, Thach Pham, Garth R Jacobsen, MD, FACS, Bryan J Sandler, MD, Santiago Horgan, MD, FACS. University Of California – San Diego
Objective: This study aims to evaluate the utility and efficiency of ICG as an alternative to routine intraoperative cholangiogram in patients undergoing cholecystectomy
Introduction: Common bile duct injury is an uncommon, but serious complication associated with laparoscopic cholecystectomy. Current guidelines state that when used routinely intraoperative cholangiogram (IOC) can decrease biliary injury, however it is not routinely used due to increased time of operation, and inaccessibility of equipment. Indocyanine Green (ICG) has been found to be effective for identification of biliary anatomy during cholecystectomy, however has not yet been widely adopted. We aim to assess if ICG is able to overcome the obstacles of IOC, while still effectively assessing biliary anatomy.
Methods: We performed a retrospective analysis of laparoscopic cholecystectomies performed in a single institution from January 2014 to September 2017. Elective and emergent cases were included. We stratified patients into ICG and non-ICG groups. Patients who had concomitant procedures performed were excluded. We analyzed patient demographic information, as well as BMI, ASA classification and comorbidities in both groups. Our primary outcome was operation time (skin to skin), and laparotomy conversion rate. Secondary outcomes were effectiveness of ICG in visualizing biliary anatomy, and cost.
Results: 145 patients were included in our study, 59 in the non-ICG arm and 86 in the ICG arm. Both groups were similar in background. There were no statistical differences in patient demographics, ASA classification, BMI, or comorbidities. There was no statistical difference in operation time (58.0 vs 54.5 minutes; p < 0.202) or conversion rate (1.6 vs 0 %; p < 0.226). ICG was able to delineate biliary anatomy in 100% of the patients. The cost of a 25 mg/Vial kit of ICG is approximately $70.
Conclusion: The use of ICG does not increase operating time during laparoscopic cholecystectomy. ICG is an inexpensive and effective tool used to delineate biliary anatomy without the inherent burden and limitations of IOC.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87852
Program Number: P105
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster