Fluorescent Imaging With Indocyanine Green During Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury.
BACKGROUND
Although rare, injury to the common bile duct (CBD) during laparoscopic cholecystectomy (LC) can be reduced by better intraoperative visualization of the cystic duct (CD) and CBD. The aim of this study was to establish the efficacy of early visualization of the CD and the added value of CBD identification, using near-infrared (NIR) light and the fluorescent agent indocyanine green (ICG), in patients at increased risk of bile duct injury.


METHODS
Patients diagnosed with complicated cholecystitis and scheduled for LC were included. The CBD and CD were visualized with NIR light before and during dissection of the liver hilus and at critical view of safety (CVS).


RESULTS
Of the 20 patients originally included, 2 were later excluded due to conversion. In 6 of 18 patients, the CD was visualized early during dissection and prior to imaging with conventional white light. The CBD was additionally visualized with ICG-NIR in 7 of 18 patients. In 1 patient, conversion was prevented due to detection of the CD and CBD with ICG-NIR.


CONCLUSIONS
Early visualization of the CD or additional identification of the CBD using ICG-NIR in patients with complicated cholecystolithiasis can be helpful in preventing CBD injury. Future studies should attempt to establish the optimal dosage and time frame for ICG administration and bile duct visualization with respect to different gallbladder pathologies.
1 VU University Medical Centre, Amsterdam, The Netherlands.
Marjolein
M
Ankersmit
1 VU University Medical Centre, Amsterdam, The Netherlands.
Dieuwertje A
DA
van Dam
1 VU University Medical Centre, Amsterdam, The Netherlands.
Anne-Sophie
AS
van Rijswijk
1 VU University Medical Centre, Amsterdam, The Netherlands.
Baukje
B
van den Heuvel
1 VU University Medical Centre, Amsterdam, The Netherlands.
Jurriaan B
JB
Tuynman
1 VU University Medical Centre, Amsterdam, The Netherlands.
Wilhelmus J H J
WJHJ
Meijerink
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000293:injuries; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003198:Computer Simulation; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000627:therapeutic use*; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods*; D061214:Patient Safety; D019265:Spectroscopy, Near-Infrared; D025321:Surgery, Computer-Assisted / Q000379:methods*
D007208:Indocyanine Green
image-guided surgery; simulation; surgical education