Intracholecystic versus Intravenous Indocyanine Green (ICG) Injection for Biliary Anatomy Evaluation by Fluorescent Cholangiography during Laparoscopic Cholecystectomy: A Case–Control Study

Abstract

(1) Background: Fluorescence cholangiography has been proposed as a method for improving the visualization and identification of extrahepatic biliary anatomy in order to possibly reduce injuries and related complications. The most common method of indocyanine green (ICG) administration is the intravenous route, whereas evidence on direct ICG injection into the gallbladder is still quite limited. We aimed to compare the two different methods of ICG administration in terms of the visualization of extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC), analyzing differences in the time of visualization, as well as the efficacy, advantages, and disadvantages of both modalities. (2) Methods: A total of 35 consecutive adult patients affected by acute or chronic gallbladder disease were enrolled in this prospective case–control study. Seventeen patients underwent LC with direct gallbladder ICG injection (IC-ICG) and eighteen subjects received intravenous ICG administration (IV-ICG). (3) Results: The groups were comparable with regard to their demographic and perioperative characteristics. The IV-ICG group had a significantly shorter overall operative time compared to the IC-ICG group (p = 0.017). IV-ICG was better at delineating the duodenum and the common hepatic duct compared to the IC-ICG method (p = 0.009 and p = 0.041, respectively). The cystic duct could be delineated pre-dissection in 76.5% and 66.7% of cases in the IC-ICG and IV-ICG group, respectively, and this increased to 88.2% and 83.3% after dissection. The common bile duct could be highlighted in 76.5% and 77.8% of cases in the IC-ICG and IV-ICG group, respectively. Liver fluorescence was present in one case in the IC-ICG group and in all cases after IV-ICG administration (5.8% versus 100%; p < 0.0001). (4) Conclusions: The present study demonstrates how ICG-fluorescence cholangiography can be helpful in identifying the extrahepatic biliary anatomy during dissection of Calot’s triangle in both administration methods. In comparison with intravenous ICG injection, the intracholecystic ICG route could provide a better signal-to-background ratio by avoiding hepatic fluorescence, thus increasing the bile duct-to-liver contrast.

Investigation of the optimal indocyanine green dose in real‐time fluorescent cholangiography during laparoscopic cholecystectomy with an ultra-high definition 4K fluorescent system: a randomized controlled trial

“…Dose, time interval, and the administration route of ICG are the three key factors that affect the cholangiographic effect during LC [10][11][12]. The administration route can be intravenous and intrabiliary [13][14][15][16]. Both routes offer images of biliary visualization in real time, which helps surgeons to select the optimal point to transect the cystic duct or hepatic duct [14].…”

“…The administration route can be intravenous and intrabiliary [13][14][15][16]. Both routes offer images of biliary visualization in real time, which helps surgeons to select the optimal point to transect the cystic duct or hepatic duct [14]. In this study, we chose the intravenous route for its easy implementation without bile leak-out, which is an advantage of the intravenous route compared to the intrabiliary route.…”

Near-infrared cholangiography with intragallbladder indocyanine green injection in minimally invasive cholecystectomy

“…The latter was achieved either through PTGBD administration in 8 cases, or gallbladder puncture in 3 cases or administration through and endoscopic nasobiliary drainage (ENBD), which was placed in situ during previous ERCP, in one case and injection of a dosage of 0.025 mg[ 21 ]. Finally, in the study of Castagneto-Gissey et al [ 22 ], a 27-gauge needle was selected for percutaneous puncture of the abdominal wall and the fundus of the gallbladder after cephalad retraction of the fundus. ICG solution was produced after dilution of a vial of ICG with a concentration of 25 mg/5 mL in 10 mL of distilled sterile water and an average of 5 mL of solution was administered, taking into consideration gallbladder dimensions and bile density.…”

“…ICG solution was produced after dilution of a vial of ICG with a concentration of 25 mg/5 mL in 10 mL of distilled sterile water and an average of 5 mL of solution was administered, taking into consideration gallbladder dimensions and bile density. The puncture point of the needle was grasped after the withdraw of the needle to prevent further dye spillage[ 22 ].…”

Enhanced visualisation of major blood vessels using multispectral NIR imaging for surgical safety

“…While this technique aids in improved vessel visualisation, some drawbacks include the time needed for preparation, potential allergic reactions to the dye, and the requirement for a dual-mode imaging modality. 5,6 In this research, we explore the potential of Near InfraRed (NIR) imaging for real-time blood vessel visualisation, eliminating the need for contrast or fluorescence dyes. We aim to generate a False-RGB image using the NIR bands that closely represents tissue colours.…”