title: Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review.
abstract: Near-infrared imaging with indocyanine green (ICG) has been extensively investigated during laparoscopic cholecystectomy (LC). However, methods vary between studies, especially regarding patient selection, dosage and timing. The aim of this systematic review was to evaluate the potential of the near-infrared imaging technique with ICG to identify biliary structures during LC.
  
  
  
  A comprehensive systematic literature search was performed. Prospective trials examining the use of ICG during LC were included. Primary outcome was biliary tract visualization. Risk of bias was assessed using ROBINS-I. Secondly, a meta-analysis was performed comparing ICG to intraoperative cholangiography (IOC) for identification of biliary structures. GRADE was used to assess the quality of the evidence.
  
  
  
  Nineteen studies were included. Based upon the pooled data from 13 studies, cystic duct (Lusch et al. in J Endourol 28:261-266, 2014) visualization was 86.5% (95% CI 71.2-96.6%) prior to dissection of Calot's triangle with a 2.5-mg dosage of ICG and 96.5% (95% CI 93.9-98.4%) after dissection. The results were not appreciably different when the dosage was based upon bodyweight. There is moderate quality evidence that the CD is more frequently visualized using ICG than IOC (RR 1.16; 95% CI 1.00-1.35); however, this difference was not statistically significant.
  
  
  
  This systematic review provides equal results for biliary tract visualization with near-infrared imaging with ICG during LC compared to IOC. Near-infrared imaging with ICG has the potential to replace IOC for biliary mapping. However, methods of near-infrared imaging with ICG vary. Future research is necessary for optimization and standardization of the near-infrared ICG technique.
authors.affiliation: Department of Surgery, VU University Medical Centre, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands. s.vlek@vumc.nl.
authors.forename: S L
authors.initials: SL
authors.lastname: Vlek
authors.affiliation: Department of Surgery, VU University Medical Centre, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
authors.forename: D A
authors.initials: DA
authors.lastname: van Dam
authors.affiliation: Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Rubinstein
authors.affiliation: Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands.
authors.forename: E S M
authors.initials: ESM
authors.lastname: de Lange-de Klerk
authors.affiliation: Medical Library, VU University, Amsterdam, The Netherlands.
authors.forename: L J
authors.initials: LJ
authors.lastname: Schoonmade
authors.affiliation: Department of Surgery, VU University Medical Centre, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
authors.forename: J B
authors.initials: JB
authors.lastname: Tuynman
authors.affiliation: Department of Surgery, VU University Medical Centre, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
authors.forename: W J H J
authors.initials: WJHJ
authors.lastname: Meijerink
authors.affiliation: Department of Surgery, VU University Medical Centre, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Ankersmit
mesh_terms: D001659:Biliary Tract / Q000000981:diagnostic imaging*; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D019265:Spectroscopy, Near-Infrared
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green
keywords: Biliary tract visualization; ICG; Intraoperative cholangiography; Laparoscopic cholecystectomy; Near-infrared imaging