Application of indocyanine green during laparoscopic cholecystectomy in elderly and senile patients

Abstract

Aim. To evaluate an effect of fluorescence cholangiography for intraoperative identification of extrahepatic bile ducts on the treatment outcomes of patients with cholelithiasis.Materials and methods. The study included 71 cholelithiasis patients who underwent laparoscopic cholecystectomy with fluorescence cholangiography and 69 cholelithiasis patients who underwent standard laparoscopic cholecystectomy. The study analyzed intraoperative damage of extrahepatic bile ducts and arteries, duration of surgery, conversion rate, need for colleague assistance, incidence of postoperative complications, hospital length of stay, and outcomes.Results. Fluorescence of the vesicular duct was achieved in 100% of patients, of the common bile duct – in 91%, and of the common hepatic duct – in 64%. A correlation between the number/type of complications and the application of ICG-diagnostics was found statistically significant (p <0.001, p = 0.012), thereby indicating the advantages of the method. The colleague-surgeon assistance was required in the ICG group 35 times less than in the standard surgery group (OR = 0.029; 95% CI = 0.003–0.319). A 34-minute reduction in surgery duration (linear regression) can be expected when performing ICG-guided surgery.Conclusion. The application of fluorescence cholangiography reduces the probability of postoperative complications, in particular, biliary leakage with the necessity of reoperation. Due to the method, a surgeon appears able to complete the operation independently without colleague assistance. Treatment outcomes, incidence of bile duct injuries, and conversion rate are yet to be investigated.