Effectiveness of Intraoperative Cholangiography Using Indocyanine Green (Versus Contrast Fluid) for the Correct Assessment of Extrahepatic Bile Ducts During Day-Case Laparoscopic Cholecystectomy

Prevot, F.; Rebibo, Lionel; Cossé, Cyril; Browet, F.; Sabbagh, Charles; Régimbeau, Jean Marc

doi:10.1007/s11605-014-2560-y

Cited by 32 publications

(24 citation statements)

References 23 publications

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“…Second, overall visualization rates of the CD and CBD with NIR fluorescence were much lower than the visualization rates described for uncomplicated cases of cholecystolithiasis. 24-38 …”

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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“…Second, overall visualization rates of the CD and CBD with NIR fluorescence were much lower than the visualization rates described for uncomplicated cases of cholecystolithiasis. 24-38 …”

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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“…Ishizawa and colleagues first described intraoperative fluorescence cholangiography. Several groups have found fluorescence cholangiography to be feasible, but it has not been validated against X‐ray cholangiography.…”

Section: Introductionmentioning

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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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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“…Several dosage schemes were used: a fixed dosage of 2.5 mg ICG was used in nine studies [16, 26, 27, 31, 33, 35, 37–39], a dosage of 0.05 mg/kg bodyweight was used in six studies [28–30, 32, 34, 40], a dosage of 0.5 mg/kg bodyweight was used in two studies [25, 36] and two studies reported other dosage schemes [15, 41]. For analysis of biliary tract identification, the studies providing information on dosage scheme were stratified by fixed dosage (2.5 mg) and dosage per kilogram bodyweight (0.05 mg/kg) as given in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…No studies reported on the CHD and CD-j visualization after dissection. Two studies have used a dosage scheme of 0.5 mg/kg bodyweight, of which one has evaluated visualization of the biliary structures before and after dissection in 23 patients [36]. Two included studies with different dosage schemes [15, 41] did not report on biliary tract visualization.…”

Section: Resultsmentioning

confidence: 99%

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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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Effectiveness of Intraoperative Cholangiography Using Indocyanine Green (Versus Contrast Fluid) for the Correct Assessment of Extrahepatic Bile Ducts During Day-Case Laparoscopic Cholecystectomy

Abstract: IOC-IG was feasible and safe. Our results suggest that this technique is more effective than IOC-CF for biliary tract identification after dissection and may constitute a powerful diagnostic test for the detection of extrahepatic ducts.

Cited by 32 publications

References 23 publications

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

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

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

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

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