Abstract
Background
This article aims to analyze and to simplify the optimal dose and time of intravenous
indocyanine green (ICG) administration to achieve the identification of the cystic
duct and the common bile duct (CBD).
Methods
A consecutive series of 146 patients was prospectively analyzed and divided into three
groups according to the time of ICG administration: at induction of anesthesia group
(20–30 min); hours before group (between 2 and 6 h); and the day before group (≥6 h);
and two groups according to the dose of ICG: 1 cc (2.5 mg) or weight-based dose (0.05 mg/kg).
Results
The CBD was better visualized in the at induction of anesthesia group (85.4%), in
the hours before group (97.1%) (p = 0.002) and in the 1cc group (p = 0.011). When we analyzed the 1 cc group (n = 126) a greater visualization of the CBD was observed in the at induction of anesthesia
group (86.7%) and in the hours before group (97.1%) (p = 0.027).
Conclusion
Due to its simplicity and reproducibility, we suggest a dose of 2.5 mg administered
2–6 h before the procedure is the optimal. However, ICG administered 30 min prior
to the surgery is enough for adequate visualization of biliary structures.
Keywords
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References
- Consensus conference statement on the general use of near-infrared fluorescence imaging and indocyanine green guided surgery: results of a modified delphi study.Ann Surg. 2020; (Nov 17)https://doi.org/10.1097/SLA.0000000000004412
- Visualization and quantification of anastomotic perfusion in colorectal surgery using near-infrared fluorescence.Tech Coloproctol. 2019; 23 (Oct): 973-980https://doi.org/10.1007/s10151-019-02089-5
- Indocyanine green fluorescence imaging in colorectal surgery: overview, applications, and future directions.Lancet Gastroenterol Hepatol. 2017; 2 (Oct): 757-766https://doi.org/10.1016/S2468-1253(17)30216-9
- Applications of indocyanine green-enhanced fluorescence in laparoscopic colorectal resections.Updates Surg. 2019; 71 (Mar): 83-88https://doi.org/10.1007/s13304-018-00609-w
- Diagnostic value of near-infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: a systematic review and meta-analysis.J Surg Oncol. 2018; 118: 1243-1256https://doi.org/10.1002/jso.25285
- Real-time identification of liver cancers by using indocyanine green fluorescent imaging.Cancer. 2009; 115 (Jun 1): 2491-2504https://doi.org/10.1002/cncr.24291
- Near-infrared fluorescence-guided resection of colorectal liver metastases.Cancer. 2013; 119 (Sep 15): 3411-3418https://doi.org/10.1002/cncr.28203
- Fluorescence-guided surgery for liver tumors.J Surg Oncol. 2018; 118 (Aug): 324-331https://doi.org/10.1002/jso.25128
- Fluorescent cholangiography significantly improves patient outcomes for laparoscopic cholecystectomy.Surg Endosc. 2021; 35 (Oct): 5729-5739https://doi.org/10.1007/s00464-020-08045-x
- Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer: a randomized clinical trial.JAMA Surg. 2020; 155 (Apr 1): 300-311https://doi.org/10.1001/jamasurg.2019.6033
- Detection of the sentinel node in pancreatic cancer by fluorescence imaging.Cir Esp. 2020; 98 (Engl Ed)MayEnglish, Spanish: 301-303https://doi.org/10.1016/j.ciresp.2019.08.001
- Avoidance of biliary injury during laparoscopic cholecystectomy.J Hepatobiliary Pancreat Surg. 2002; 9: 543-547https://doi.org/10.1007/s005340200071
- Fluorescent cholangiography using indocyanine green for laparoscopic cholecystectomy: an initial experience.Arch Surg. 2009; 144 (Apr): 381-382https://doi.org/10.1001/archsurg.2009.9
- Randomized trial of near-infrared incisionless fluorescent cholangiography.Ann Surg. 2019; 270 (Dec): 992-999https://doi.org/10.1097/SLA.0000000000003178
- Does near-infrared fluorescent cholangiography with indocyanine green reduce bile duct injuries and conversions to open surgery during laparoscopic or robotic cholecystectomy? - A meta-analysis.Surgery. 2021; 169 (Apr): 859-867https://doi.org/10.1016/j.surg.2020.12.008
- Consensus guidelines for the use of fluorescence imaging in hepatobiliary surgery.Ann Surg. 2021; 274 (Jul 1): 97-106https://doi.org/10.1097/SLA.0000000000004718
- Fluorescence-based cholangiography: preliminary results from the IHU-IRCAD-EAES EURO-FIGS registry.Surg Endosc. 2020; 34 (Sep): 3888-3896https://doi.org/10.1007/s00464-019-07157-3
- Direct gallbladder indocyanine green injection fluorescence cholangiography during laparoscopic cholecystectomy.J Laparoendosc Adv Surg Tech A. 2017; 27 (Oct): 1069-1073https://doi.org/10.1089/lap.2017.0070
- Fluorescent cholangiography with direct injection of indocyanine green (ICG) into the gallbladder: a safety method to outline biliary anatomy.Langenbecks Arch Surg. 2020; 405 (Sep): 827-832https://doi.org/10.1007/s00423-020-01967-z
- Optimal timing of preoperative indocyanine green administration for fluorescent cholangiography during laparoscopic cholecystectomy using the PINPOINT® endoscopic fluorescence imaging system.Asian J Endosc Surg. Aug 2018; 11: 199-205https://doi.org/10.1111/ases.12440
- Optimizing the image of fluorescence cholangiography using ICG: a systematic review and ex vivo experiments.Surg Endosc. 2018; 32 (Dec): 4820-4832https://doi.org/10.1007/s00464-018-6233-x
- Micro-dosing of indocyanine green for intraoperative fluorescence cholangiography.Surg Technol Int. 2021; 38 (May 20): 98-101https://doi.org/10.52198/21.STI.38.GS1388
- Intraoperative laparoscopic near-infrared fluorescence cholangiography to facilitate anatomical identification: when to give indocyanine green and how much.Surg Innov. 2016; 23 (Aug): 360-365https://doi.org/10.1177/1553350616637671
- Intraoperative exploration of biliary anatomy using fluorescence imaging of indocyanine green in experimental and clinical cholecystectomies.J Hepatobiliary Pancreat Sci. 2010; 17 (Sep): 595-600https://doi.org/10.1007/s00534-009-0195-2
- The best approach for laparoscopic fluorescence cholangiography: overview of the literature and optimization of dose and dosing time.Surg Innov. 2017; 24 (Aug): 386-396https://doi.org/10.1177/1553350617702311
- Clinical value and pitfalls of fluorescent cholangiography during single-incision laparoscopic cholecystectomy.Surg Today. Dec 2016; 46: 1443-1450https://doi.org/10.1007/s00595-016-1330-8
- Accuracy of near infrared-guided surgery in morbidly obese subjects undergoing laparoscopic cholecystectomy.Obes Surg. 2016; 26 (Mar): 525-530https://doi.org/10.1007/s11695-015-1781-9
Article Info
Publication History
Published online: November 18, 2022
Accepted:
October 23,
2022
Received:
May 11,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
