Accuracy of Near Infrared-Guided Surgery in Morbidly Obese Subjects Undergoing Laparoscopic Cholecystectomy

Dip, Fernando; Nguyen, David; Montorfano, Lisandro; Noste, María Eugenia Szretter; Menzo, Emanuele Lo; Simpfendorfer, Conrad; Szomstein, Samuel; Rosenthal, Raúl J.

doi:10.1007/s11695-015-1781-9

Cited by 39 publications

(32 citation statements)

References 28 publications

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“…The RCT was not powered to visualize deep bile duct structures, but the limited visualization rate in the fluorescence cholangiography group was probably due to low penetration of the emitted fluorescent light through the overlying liver and fatty tissue. A high BMI may hinder visualization of the bile ducts, although findings have not been uniform. The inability of fluorescence cholangiography to visualize the left and right hepatic ducts was not at the expense of its ability to obtain the critical view of safety.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of previous investigations were small, prospective non‐controlled and controlled studies, and these indicated that the ability of fluorescence cholangiography to visualize the critical junction was equal to that of X‐ray cholangiography. A recent RCT including 639 patients compared fluorescence cholangiography with white light (normal vision) and not with X‐ray cholangiography as the standard.…”

Section: Discussionmentioning

confidence: 99%

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Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

Lehrskov

Westen²,

Larsen³

et al. 2020

British Journal of Surgery

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Background: Safe laparoscopic cholecystectomy may necessitate biliary imaging, and non-invasive fluorescence cholangiography may have advantages over contrast X-ray cholangiography. This trial compared fluorescence and X-ray cholangiography for visualization of the critical junction between the cystic, common hepatic and common bile ducts. Methods: This non-inferiority blinded RCT included patients who had either intraoperative fluorescence cholangiography using 0⋅05 mg/kg indocyanine green or X-ray cholangiography during elective laparoscopic cholecystectomy.Results: Between March 2015 and August 2018, a total of 120 patients were randomized (60 in each group). There were no drop-outs and 30-day follow-up data were available for all patients. In intention-to-treat analysis, there was no difference between the fluorescence and X-ray cholangiography groups in ability to visualize the critical junction (49 of 60 versus 51 of 60 respectively; P = 0⋅230). Fluorescence cholangiography was faster by a few minutes: median 2⋅0 (range 0⋅5-5⋅0) versus 4⋅8 (1⋅3-17⋅6) min (P < 0⋅001).Conclusion: Fluorescence cholangiography was confirmed to be non-inferior to X-ray cholangiography in visualizing the critical junction during laparoscopic cholecystectomy. Registration number: NCT02344654 (http://www.clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

Lehrskov

Westen²,

Larsen³

et al. 2020

British Journal of Surgery

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“…In agreement with current literature, we did not find significant differences in BMI in our patients in relation to successful or unsuccessful imaging of bile duct structures. 44 We hypothesize that other patient and surgical-related factors, including inflamed tissue, may interfere with and influence the success rate of fluorescence visualization of the bile ducts in complicated cases.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Six studies were stratified to the 0.05 mg/kg bodyweight group encompassing 274 patients [28–30, 32, 34, 40]. One study reported on visualization of the CD-j before dissection with positive identification in 35 of 35 cases [34].…”

Section: Resultsmentioning

confidence: 99%

Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review

et al. 2016

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BackgroundNear-infrared imaging with indocyanine green (ICG) has been extensively investigated during laparoscopic cholecystectomy (LC). However, methods vary between studies, especially regarding patient selection, dosage and timing. The aim of this systematic review was to evaluate the potential of the near-infrared imaging technique with ICG to identify biliary structures during LC.MethodsA comprehensive systematic literature search was performed. Prospective trials examining the use of ICG during LC were included. Primary outcome was biliary tract visualization. Risk of bias was assessed using ROBINS-I. Secondly, a meta-analysis was performed comparing ICG to intraoperative cholangiography (IOC) for identification of biliary structures. GRADE was used to assess the quality of the evidence.ResultsNineteen studies were included. Based upon the pooled data from 13 studies, cystic duct (Lusch et al. in J Endourol 28:261–266, 2014) visualization was 86.5% (95% CI 71.2–96.6%) prior to dissection of Calot’s triangle with a 2.5-mg dosage of ICG and 96.5% (95% CI 93.9–98.4%) after dissection. The results were not appreciably different when the dosage was based upon bodyweight. There is moderate quality evidence that the CD is more frequently visualized using ICG than IOC (RR 1.16; 95% CI 1.00–1.35); however, this difference was not statistically significant.ConclusionThis systematic review provides equal results for biliary tract visualization with near-infrared imaging with ICG during LC compared to IOC. Near-infrared imaging with ICG has the potential to replace IOC for biliary mapping. However, methods of near-infrared imaging with ICG vary. Future research is necessary for optimization and standardization of the near-infrared ICG technique.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-016-5318-7) contains supplementary material, which is available to authorized users.

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Accuracy of Near Infrared-Guided Surgery in Morbidly Obese Subjects Undergoing Laparoscopic Cholecystectomy

Abstract: Fluorescent cholangiography is a useful technique in the obese and non-obese population. Obesity does not affect fluorescence visualization of bile ducts.

Cited by 39 publications

References 28 publications

Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

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

Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review

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