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Fluorescence-based cholangiography: preliminary results from the IHU-IRCAD-EAES EURO-FIGS registry

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Abstract

Introduction

Near-infrared fluorescence cholangiography (NIRF-C) is a popular application of fluorescence image-guided surgery (FIGS). NIRF-C requires near-infrared optimized laparoscopes and the injection of a fluorophore, most frequently Indocyanine Green (ICG), to highlight the biliary anatomy. It is investigated as a tool to increase safety during cholecystectomy. The European registry on FIGS (EURO-FIGS: www.euro-figs.eu) aims to obtain a snapshot of the current practices of FIGS across Europe. Data on NIRF-C are presented.

Methods

EURO-FIGS is a secured online database which collects anonymized data on surgical procedures performed using FIGS. Data collected for NIRF-C include gender, age, Body Mass Index (BMI), pathology, NIR device, ICG dose, ICG timing of administration before intraoperative visualization, visualization (Y/N) of biliary structures such as the cystic duct (CD), the common bile duct (CBD), the CD-CBD junction, the common hepatic duct (CHD), Visualization scores, adverse reactions to ICG, operative time, and surgical complications.

Results

Fifteen surgeons (12 European surgical centers) uploaded 314 cases of NIRF-C during cholecystectomy (cholelithiasis n = 249, cholecystitis n = 58, polyps n = 7), using 4 different NIR devices. ICG doses (mg/kg) varied largely (mean 0.28 ± 0.17, median 0.3, range: 0.02–0.62). Similarly, injection-to-visualization timing (minutes) varied largely (mean 217 ± 357; median 57), ranging from 1 min (direct intragallbladder injection in 2 cases) to 3120 min (n = 2 cases). Visualization scores before dissection were significantly correlated, at univariate analysis, with ICG timing (all structures), ICG dose (CD-CBD), device (CD and CD-CBD), surgeon (CD and CD-CBD), and pathology (CD and CD-CBD). BMI was not correlated. At multivariate analysis, pathology and timing remained significant factors affecting the visualization scores of all three structures, whereas ICG dose remained correlated with HD visualization only.

Conclusions

The EURO-FIGS registry has confirmed a wide disparity in ICG dose and timing in NIRF-C. EURO-FIGS can represent a valuable tool to promote and monitor FIGS-related educational and consensus activities in Europe.

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Acknowledgements

The EURO-FIGS registry is a joint effort between the IRCAD, IHU-Strasbourg, and the Technology Committee of the European Association of Endoscopic Surgeons (EAES). The authors are grateful to Camille Goustiaux, Guy Temporal, and Christopher Burel, professionals in Medical English proofreading, for their valuable assistance.

Funding

The EURO-FIGS registry is funded by a grant from the ARC Foundation for Cancer Research (9, rue Guy Môquet; 94803 Villejuif Cedex, France, www.fondation-arc.org), within the framework of the ELIOS (Endoscopic Luminescent Imaging for precision Oncologic Surgery) project.

Author information

Authors and Affiliations

  1. IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France

    Vincent Agnus, Jacques Marescaux & Michele Diana

  2. Department of Medical Surgical Sciences and Advanced Technologies “Ingrassia”, Cannizzaro Hospital, University of Catania, Catania, Italy

    Antonio Pesce & Gaetano La Greca

  3. Department of Surgery, IRCCS - Ca’ Granda - University Hospital of Milan, Milan, Italy

    Luigi Boni

  4. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    Jacqueline Van Den Bos

  5. Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital “Virgen del Rocio”, University of Seville, Seville, Spain

    Salvador Morales-Conde

  6. Obesity and Minimally Invasive Surgery Division, Department of Cardiothoracic, Vascular Surgery, and Organ Transplantation, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy

    Alessandro M. Paganini, Silvia Quaresima & Andrea Balla

  7. Department of General and Emergency Surgery, Riga East Clinical University Hospital “Gailezers”, Riga, Latvia

    Haralds Plaudis

  8. Department of General Surgery, Ospedale Pederzoli, Peschiera del Garda, Verona, Italy

    Gianluigi Moretto

  9. Ente Ospedaliero Ospedali Galliera, Genoa, Italy

    Maurizio Castagnola

  10. Azienda Unità Sanitaria Locale di Parma, Ospedale di Fidenza, Parma, Italy

    Caterina Santi, Lorenzo Casali & Luciano Tartamella

  11. Department of General Surgery, Hospital of Pourtalès, Neuchâtel, Switzerland

    Alend Saadi & Michele Diana

  12. General and Colorectal Surgery Division, Department of Cardiothoracic, Vascular Surgery and Organ Transplantation, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy

    Andrea Picchetto

  13. Department of Surgical Sciences, University of Torino, Turin, Italy

    Alberto Arezzo

  14. IRCAD, Research Institute Against Cancer of the Digestive System, 1, Place de l’Hôpital, 67091, Strasbourg, France

    Jacques Marescaux & Michele Diana

Authors
  1. Vincent Agnus
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  2. Antonio Pesce
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  19. Jacques Marescaux
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  20. Michele Diana
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Corresponding author

Correspondence to Michele Diana.

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Disclosures

Michele Diana is PI and the recipient of the ELIOS grant. Jacques Marescaux is President of both the IRCAD and IHU Institutes, which are partly funded by KARL STORZ, Medtronic, and Siemens Healthcare. Luigi Boni reports consulting position with various companies outside the submitted work. Vincent Agnus, Antonio Pesce, Jacqueline Van Den Bos, Salvador Morales-Conde, Alessandro Paganini, Silvia Quaresima, Andrea Balla, Gaetano La Greca, Haralds Plaudis, Gianluigi Moretto, Maurizio Castagnola, Caterina Santi, Lorenzo Casali, Luciano Tartamella, Alend Saadi, Andrea Picchetto, Alberto Arezzo have no conflicts of interest or financial ties to disclose.

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Agnus, V., Pesce, A., Boni, L. et al. Fluorescence-based cholangiography: preliminary results from the IHU-IRCAD-EAES EURO-FIGS registry. Surg Endosc 34, 3888–3896 (2020). https://doi.org/10.1007/s00464-019-07157-3

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