title: Intraoperative Laparoscopic Near-Infrared Fluorescence Cholangiography to Facilitate Anatomical Identification: When to Give Indocyanine Green and How Much.
abstract: Recent technological advances have enabled real-time near-infrared fluorescence cholangiography (NIRFC) with indocyanine green (ICG). Whereas several studies have shown its feasibility, dosing and timing for practical use have not been optimized. We undertook a prospective study with systematic variation of dosing and timing from injection of ICG to visualization. Adult patients undergoing laparoscopic biliary and hepatic operations were enrolled. Intravenous ICG (0.02-0.25 mg/kg) was administered at times ranging from 10 to 180 minutes prior to planned visualization. The porta hepatis was examined using a dedicated laparoscopic system equipped to detect NIRFC. Quantitative analysis of intraoperative fluorescence was performed using a scoring system to identify biliary structures. A total of 37 patients were enrolled. Visualization of the extrahepatic biliary tract improved with increasing doses of ICG, with qualitative scores improving from 1.9 ± 1.2 (out of 5) with a 0.02-mg/kg dose to 3.4 ± 1.3 with a 0.25-mg/kg dose (P < .05 for 0.02 vs 0.25 mg/kg). Visualization was also significantly better with increased time after ICG administration (1.1 ± 0.3 for 10 minutes vs 3.4 ± 1.1 for 45 minutes, P < .01). Similarly, quantitative measures also improved with both dose and time. There were no complications from the administration of ICG. These results suggest that a dose of 0.25 mg/kg administered at least 45 minutes prior to visualization facilitates intraoperative anatomical identification. The dosage and timing of administration of ICG prior to intraoperative visualization are within a range where it can be administered in a practical, safe, and effective manner to allow intraoperative identification of extrahepatic biliary anatomy using NIRFC.
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA, USA azarrinpar@mednet.ucla.edu.
authors.forename: Ali
authors.initials: A
authors.lastname: Zarrinpar
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Erik P
authors.initials: EP
authors.lastname: Dutson
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Constance
authors.initials: C
authors.lastname: Mobley
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Areti
authors.initials: A
authors.lastname: Tillou
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Cheaito
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: O Joe
authors.initials: OJ
authors.lastname: Hines
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Vatche G
authors.initials: VG
authors.lastname: Agopian
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Darryl T
authors.initials: DT
authors.lastname: Hiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D004396:Coloring Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D018579:Patient Selection; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: biliary anatomy; infrared fluorescence; intraoperative cholangiography; intraoperative guidance