Indocyanine green fluorescent cholangiography improves the clinical effects of difficult laparoscopic cholecystectomy

Xu, Chengfan; Yin, Maohui; Wang, Haitao; Jiang, Ping; Yang, Zhiyong; Ya, HE; Zhang, Zhonglin; Liu, Zhisu; Liao, Bo; Yua, Yuan

doi:10.1007/s00464-023-10035-8

Cited by 15 publications

(5 citation statements)

References 32 publications

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“…For example, Xu et al reported a preference for utilizing ICG fluorescence imaging assistance in challenging laparoscopic cholecystectomy procedures. 15 Moreover, the disparity in body mass index (BMI) between the 2 patient groups may indeed contribute to the observed heterogeneity in our study. Ma’s study, for instance, revealed that patients in the ICG group had a higher BMI compared to those in the control group.…”

Section: Discussionmentioning

confidence: 90%

“…A total of 1148 studies were initially identified, and after careful evaluation, 14 studies 13,[15][16][17][18][19][20][21][22][23][24][25][26][27] were included in this meta-analysis. The selection procedures followed the PRISMA flowchart (Figure 1).…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…The primary objective of this study was to assess the effect of fluorescein ICG assistance on the occurrence of postoperative complications following cholecystectomy. Ultimately, our meta-analysis incorporated a total of 12 studies, [13][14][15][16][17][18][19][20][21][22][23][24] encompassing 3024 patients, to investigate this specific outcome. Among the patients, the incidence of total postoperative complications in the ICG group was 4.78%, compared to 7.25% in the control group (RR .71; 95%CI: .54-.95) (Figure 3A).…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Effects of Indocyanine Green (ICG) Imaging-Assisted Cholecystectomy on Intraoperative and Postoperative Complications: A meta-Analysis

Tang,

Liu,

Liu

et al. 2024

Surg Innov

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Background Accurate recognition of Calot’s triangle during cholecystectomy is important in preventing intraoperative and postoperative complications. The use of indocyanine green (ICG) fluorescence imaging has become increasingly prevalent in cholecystectomy procedures. Our study aimed to evaluate the specific effects of ICG-assisted imaging in reducing complications. Materials and Methods A comprehensive search of databases including PubMed, Web of Science, Europe PMC, and WANFANGH DATA was conducted to identify relevant articles up to July 5, 2023. Review Manager 5.3 software was applied to statistical analysis. Results Our meta-analysis of 14 studies involving 3576 patients compared the ICG group (1351 patients) to the control group (2225 patients). The ICG group had a lower incidence of postoperative complications (4.78% vs 7.25%; RR .71; 95%CI: .54-.95; P = .02). Bile leakage was significantly reduced in the ICG group (.43% vs 2.02%; RR = .27; 95%CI: .12-.62; I2 = 0; P = .002), and they also had a lower bile duct drainage rate (24.8% vs 31.8% RR = .64, 95% CI: .44-.91, P = .01). Intraoperative complexes showed no statistically significant difference between the 2 groups (1.16% vs 9.24%; RR .17; 95%CI .03-1.02), but the incidence of intraoperative bleeding is lower in the ICG group. Conclusion ICG fluorescence imaging-assisted cholecystectomy was associated with a range of benefits, including a lower incidence of postoperative complications, decreased rates of bile leakage, reduced bile duct drainage, fewer intraoperative complications, and reduced intraoperative bleeding.

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Section: Discussionmentioning

confidence: 90%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Effects of Indocyanine Green (ICG) Imaging-Assisted Cholecystectomy on Intraoperative and Postoperative Complications: A meta-Analysis

Tang,

Liu,

Liu

et al. 2024

Surg Innov

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“…Dissection of the common bile duct could lead to collateral damage and hemorrhage. 31 ICG-FI enables the surgeon to visualize the shape of the extrahepatic bile ducts, [32][33][34] in combination with 3DVT to accurately locate crucial vascular structures, 35 thereby reducing surgical iatrogenic injuries. The surgical treatment of diffuse hepatolithiasis is challenging, as hepatectomy combined with choledochotomy fails to completely remove all stones in the distal intrahepatic bile ducts.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of hepatectomy for hepatolithiasis using 3D visualization combined with ICG fluorescence imaging: A retrospective cohort study

Huang,

Zeng,

Zeng

et al. 2024

World j. surg.

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BackgroundHepatolithiasis is a complex condition that poses challenges and difficulties in surgical treatment. Three‐dimensional visualization technology combined with fluorescence imaging (3DVT‐FI) enables accurate preoperative assessment and real‐time intraoperative navigation. However, the perioperative outcomes of 3DVT‐FI in hepatolithiasis have not been reported. We aim to evaluate the efficacy of 3DVT‐FI in the treatment of hepatolithiasis.MethodsA retrospective analysis was performed on 128 patients who underwent hepatectomy for hepatolithiasis at the Department of Hepatobiliary Surgery, Zhujiang Hospital, between January 2017 and December 2022. Among them, 50 patients underwent hepatectomy using 3DVT‐FI (3DVT‐FI group), while 78 patients underwent conventional hepatectomy without 3DVT‐FI (CH group). The operative data, postoperative liver function indices, complication rates and stone residue were compared between the two groups.ResultsThere were no significant differences in preoperative baseline data between the two groups (p > 0.05). Compared with the CH group, the 3DVT‐FI group exhibited lower intraoperative blood loss (140.00 ± 112.12 vs. 225.99 ± 186.50 mL, p = 0.001), and a lower intraoperative transfusion rate (8.0% vs. 23.1%, p = 0.027). The overall incidence of postoperative complications did not differ significantly (22.0% vs. 35.9%, p = 0.096). The 3DVT‐FI group was associated with a lower immediate residual stone rate (16.0% vs. 34.6%, p = 0.021). There were no perioperative deaths in the 3DVT‐FI group, while one perioperative death occurred in the CH group.ConclusionsThe 3DVT‐FI may offer significant benefits in terms of surgical safety, reduced intraoperative bleeding and decreased stone residue during hepatectomy for hepatolithiasis.

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“…When the critical view of safety cannot be achieved, the surgical team should be prepared to use a bailout procedure or conversion to open surgery. Recently, the intraoperative use of near-infrared indocyanine green fluorescent cholangiography (NIRFC) has provided a valuable tool to shorten the operation time and reduce blood loss and the incidence of biliary injuries [27,28].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis

Stoica,

Serban,

Bratu

et al. 2024

Diagnostics

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Laparoscopic cholecystectomy (LC) is the gold standard treatment in acute cholecystitis. However, one in six cases is expected to be difficult due to intense inflammation and suspected adherence to and involvement of adjacent important structures, which may predispose patients to higher risk of vascular and biliary injuries. In this study, we aimed to identify the preoperative parameters with predictive value for surgical difficulties. A retrospective study of 255 patients with acute cholecystitis admitted in emergency was performed between 2019 and 2023. Patients in the difficult laparoscopic cholecystectomy (DLC) group experienced more complications compared to the normal LC group (33.3% vs. 15.3%, p < 0.001). Age (p = 0.009), male sex (p = 0.03), diabetes (p = 0.02), delayed presentation (p = 0.03), fever (p = 0.004), and a positive Murphy sign (p = 0.007) were more frequently encountered in the DLC group. Total leukocytes, neutrophils, and the neutrophil-to-lymphocyte ratio (NLR) were significantly higher in the DLC group (p < 0.001, p = 0.001, p = 0.001 respectively). The Tongyoo score (AUC ROC of 0.856) and a multivariate model based on serum fibrinogen, thickness of the gallbladder wall, and transverse diameter of the gallbladder (AUC ROC of 0.802) showed a superior predictive power when compared to independent parameters. The predictive factors for DLC should be assessed preoperatively to optimize the therapeutic decision.

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Indocyanine green fluorescent cholangiography improves the clinical effects of difficult laparoscopic cholecystectomy

Cited by 15 publications

References 32 publications

Effects of Indocyanine Green (ICG) Imaging-Assisted Cholecystectomy on Intraoperative and Postoperative Complications: A meta-Analysis

Effects of Indocyanine Green (ICG) Imaging-Assisted Cholecystectomy on Intraoperative and Postoperative Complications: A meta-Analysis

Efficacy of hepatectomy for hepatolithiasis using 3D visualization combined with ICG fluorescence imaging: A retrospective cohort study

Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis

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