title: Comparing Near-Infrared Imaging with Indocyanine Green to Conventional Imaging During Laparoscopic Cholecystectomy: A Prospective Crossover Study.
abstract: BACKGROUND
  The aim of this study was to test and validate a novel noninvasive method for intraoperative visualization of extrahepatic bile ducts during laparoscopic cholecystectomy. Injury to the common bile duct (CBD) is a rare but major complication of laparoscopic cholecystectomy. Most injuries occur when anatomy is unclear due to the presence of anatomic variations, acute inflammation, or adhesions.
  
  
  METHODS
  Thirty patients were included, and each received an intravenous injection of 0.05 mg/kg of indocyanine green (ICG) (ICG-Pulsion(®); PULSION Medical Systems AG, Munich, Germany) prior to the start of surgery. Laparoscopic cholecystectomy was performed according to standard procedures. The CBD and cystic duct (CD) were visualized before and during dissection of the liver hilus using a conventional laparoscopic camera and a recently developed near-infrared (NIR) camera (Olympus, Tokyo, Japan).
  
  
  RESULTS
  Using ICG-NIR, the CBD and CD could be visualized 11 minutes (P=.008) and 8.6 minutes (P=.001) earlier than with a conventional camera. Both early (20/30 patients) and late (26/30 patients) identification of the CBD with ICG-NIR was significantly more frequent compared with conventional images (2/30 and 10/30, respectively; P<.001). One postoperative bilioma required re-admission and endoscopic retrograde cholangiopancreatography with stent placement.
  
  
  CONCLUSIONS
  Identification of the CBD and CD using a low dose of ICG and the NIR camera was both faster and more frequent compared with conventional laparoscopic images during elective laparoscopic cholecystectomy.
authors.affiliation: 1 Department of Surgery, VU University Medical Centre , Amsterdam, The Netherlands .
authors.forename: Dieuwertje A
authors.initials: DA
authors.lastname: van Dam
authors.affiliation: 1 Department of Surgery, VU University Medical Centre , Amsterdam, The Netherlands .
authors.forename: Marjolein
authors.initials: M
authors.lastname: Ankersmit
authors.affiliation: 2 Department of Epidemiology, VU University Medical Centre , Amsterdam, The Netherlands .
authors.forename: Peter
authors.initials: P
authors.lastname: van de Ven
authors.affiliation: 1 Department of Surgery, VU University Medical Centre , Amsterdam, The Netherlands .
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: van Rijswijk
authors.affiliation: 1 Department of Surgery, VU University Medical Centre , Amsterdam, The Netherlands .
authors.forename: Jurriaan B
authors.initials: JB
authors.lastname: Tuynman
authors.affiliation: 1 Department of Surgery, VU University Medical Centre , Amsterdam, The Netherlands .
authors.forename: Wilhelmus J H J
authors.initials: WJ
authors.lastname: Meijerink
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging* / Q000601:surgery; D002758:Cholangiography / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000000981:diagnostic imaging* / Q000601:surgery; D003287:Contrast Media / Q000008:administration & dosage*; D018592:Cross-Over Studies; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared; D025321:Surgery, Computer-Assisted
chemical_list: D003287:Contrast Media; D007208:Indocyanine Green