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Fluorescent cholangiography with direct injection of indocyanine green (ICG) into the gallbladder: a safety method to outline biliary anatomy

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Abstract

Purpose

Near infrared cholangiography (NIRC) with indocyanine green (ICG) directly injected into the gallbladder is a novel technique to outline biliary anatomy. The purpose of this article is to analyze the usefulness and feasibility of NIRC as a safety method during laparoscopic cholecystectomies.

Material and methods

A case-controlled study comparing 20 patients undergoing laparoscopic cholecystectomies with NIRC with direct injection of ICG into the gallbladder to 20 consecutive standard cholecystectomies. Operative time, length of stay, complications, conversion rates, and biliary injury were analyzed.

Results

Both groups were comparable in epidemiological characteristics. In the ICG group fluorescent visualization of the junction of the Hartmann pouch and the whole cystic duct was achieved in 16 (80%) patients. Median surgical time was 65 (50–76) and 55 (45–71) min for the ICG and the control group, respectively (p = 0.113). There were no postoperative complications and no biliary duct injuries in any of the groups, and a patient from both groups underwent conversion to open surgery.

Conclusion

NIRC with direct injection of ICG into the gallbladder is a feasible method that is not time-consuming; it does not require a different learning curve from standard laparoscopic cholecystectomies and has no major complications described so far.

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Authors and Affiliations

  1. Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain

    Clara Gené Škrabec, Fernando Pardo Aranda, Francisco Espín, Manel Cremades, Jordi Navinés, Alba Zárate & Esteban Cugat

  2. Department of General and Digestive Surgery, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain

    Esteban Cugat

Authors
  1. Clara Gené Škrabec
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  2. Fernando Pardo Aranda
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  3. Francisco Espín
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  4. Manel Cremades
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  5. Jordi Navinés
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  6. Alba Zárate
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  7. Esteban Cugat
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Clara Gené Škrabec and Fernando Pardo Aranda. The first draft of the manuscript was written by Clara Gené Škrabec, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fernando Pardo Aranda.

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The authors declare that they have no conflict of interest.

Ethical approval

This prospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data and photographs.

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Gené Škrabec, C., Pardo Aranda, F., Espín, F. et al. Fluorescent cholangiography with direct injection of indocyanine green (ICG) into the gallbladder: a safety method to outline biliary anatomy. Langenbecks Arch Surg 405, 827–832 (2020). https://doi.org/10.1007/s00423-020-01967-z

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