The role of indocyanine green fluoroscopy for intraoperative bile duct visualization during laparoscopic cholecystectomy: an observational cohort study in 70 patients

Peter C Ambe, Jens Plambeck, Victoria Fernandez-Jesberg, Konstantinos Zarras, Peter C Ambe, Jens Plambeck, Victoria Fernandez-Jesberg, Konstantinos Zarras

Abstract

Background: Bile duct injury is the most feared complication during laparoscopic cholecystectomy. Real-time intraoperative imaging using indocyanine green (ICG) might reduce the risk of bile duct injury by improving visualization of the biliary tree during laparoscopic cholecystectomy. We compared the outcomes of laparoscopic cholecystectomy in patients with and without real-time ICG.

Methods: A retrospective analysis of the data of patients undergoing laparoscopic cholecystectomy with and without ICG in a referral centre for minimally invasive surgery was performed. We hypothesized that laparoscopic cholecystectomy with real-time ICG enables a better identification of the biliary tree and thus increases surgical safety. The outcomes of laparoscopic cholecystectomy with and without ICG were compared using the duration of surgery, the rate of bile duct injury, the rate of conversion, complications and the length of stay.

Results: Seventy patients including 29 with and 41 without ICG underwent laparoscopic cholecystectomy within the period of investigation. The median duration of surgery was 53.0 vs. 54.0 min while the median length of stay was 2.0 d in the group with and without ICG respectively. The rate of conversion was 2.4% in the group without ICG, while no conversion was performed in the group with ICG. NO bile duct injury occurred in both groups. These differences were not statistically significant.

Conclusion: Laparoscopic cholecystectomy with real-time indocyanine green fluorescence cholangiography enables a better visualization and identification of biliary tree and therefore should be considered as a means of increasing the safety of laparoscopic cholecystectomy.

Keywords: Bile duct injury; Indocyanine green; Intraoperative fluorescence angiography; Laparoscopic cholecystectomy.

Conflict of interest statement

A written consent was received from all patients or their legal representatives for the use of their data in this study. Ethics approval was received from the Board of Review at the Witten / Herdecke University.Consent for publication was granted by all patients included in the study.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Intraoperative imaging after application of 0.5 ml of ICG. Note the cystic duct and the main bile duct. Red arrow: ductus hepaticus communis, black arrow: ductus cysticus, blue arrow: ductus choledochus
Fig. 2
Fig. 2
Intraoperative imaging with Indocyanine green. Note the clear – cut differentiation between cystic duct and cystic artery. Red lines: ductus hepaticus communis, black lines: ductus cysticus
Fig. 3
Fig. 3
Indocyanine green fluorescence angiography showing a fluorescent cystic artery. Yellow arrows: cystic artery
Fig. 4
Fig. 4
Documentation of the main bile duct at the end of gallbladder dissection. Red arrow: ductus hepaticus communis
Fig. 5
Fig. 5
Duration of Surgery. There was no statistically significant difference amongst patients under laparoscopic cholecystectomy with and without Indocyanine green

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