Indocyanine Green Imaging in Laparoscopic Cholecystectomy Plus Laparoscopic Common Bile Duct Exploration: A Suitable Option for Patients With Difficult Exploration (With Videos)

Abstract

Background: The clinical application of indocyanine green (ICG) fluorescence imaging technology in biliary surgery has gradually highlighted its role, and its role in laparoscopic cholecystectomy plus laparoscopic common bile duct exploration (LC+LCBDE) still needs to be further explored. Therefore, we evaluated the clinical value of ICG fluorescence imaging in LC+LCBDE.Materials and Methods: Data from 131 patients who underwent LC +LCBDE in our department between January 2019 and June 2021 were retrospectively collected and analyzed. Overall, 59 and 72 patients underwent ICG+LC+LCBDE and LC+LCBDE, respectively, and were assigned to the ICG (ICG+LC+LCBDE) and non-ICG (LC+LCBDE) groups based on their medical records. The clinical data of all patients were obtained, and the differences between the ICG and non-ICG groups were compared.Results: A total of 131 patients successfully underwent surgery. There were no differences in baseline characteristics between the 2 groups. In terms of perioperative results, no significant betweengroup differences in biliary tract exposure before Calot's triangle dissection were noted; however, patients in the ICG group had better biliary tract observations after Calot's triangle dissection, shorter operative time, fewer complications, earlier postoperative exhaust, and lower hospital costs.Conclusions: ICG imaging can assist surgeons in determining biliary tract structures and injuries during surgery and in preventing operation-related bile leakage. ICG imaging is a technique worthy of promotion in difficult surgery.

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

“…Ma’s study, for instance, revealed that patients in the ICG group had a higher BMI compared to those in the control group. 16 Additionally, despite efforts to minimize selection bias, the possibility of residual or unaccounted bias in the included studies cannot be completely ruled out.…”

“…We further analyzed the incidence of bile leakage and bile duct drainage among the total complications. 16,27 We found that the incidence of bile leakage was lower in the ICG group compared to the control group (RR = .27, 95% CI:0.12-.62, P = .002, I 2 = 0) (Figure 4A).…”

“…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).…”

“…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).…”

Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence

“…In cases involving suspected bile duct anatomical variations or challenging scenarios, such as previous upper abdominal operations, real-time ICG imaging is a favorable option for ductal mapping. It enhances bile duct visibility and reduces postoperative complications and bile leaks[ 61 ]. Although there is no absolute consensus, recent research suggests that the optimal dose and timing for fluorescence cholangiography with ICG were intravenous administration of 10 mg of ICG around 10–12 h before the operation, respectively[ 62 ].…”