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Indocyanine green fluorescent cholangiography improves the clinical effects of difficult laparoscopic cholecystectomy

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Abstract

Background

Near-infrared fluorescent cholangiography (NIRFC) with indocyanine green (ICG) as the developer yields clear visualization of the extrahepatic bile ducts and is effective in identifying key structures. Here, we analyzed and compared the surgical outcomes of fluorescent and conventional laparoscopy in cholecystectomy of various difficulties and then assessed the value of NIRFC.

Materials and methods

This retrospective study collected clinical data from partial patients who underwent laparoscopic cholecystectomy (LC) at the Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University between 2020 and 2021. The study subjects were classified into ICG-assisted and white-light laparoscopy. Two cohorts with homogeneous baseline status were selected based on 1:1 ratio propensity score matching (PSM). Multivariate logistic regression analysis was performed to predict independent risk factors for LC difficulty. Thereafter, the matched cases were classified into difficult and easy subgroups by combining difficulty score and gallbladder disease type, and then the surgical outcomes of the two groups were compared.

Results

This study included a total of 624 patients. The patients were classified into the ICG group (n = 218) and the non-ICG group (n = 218) after a 1:1 ratio PSM. Our data showed significant differences between the groups in operative time (P = 0.020), blood loss (P = 0.016), length of stay (P = 0.036), and adverse reaction (P = 0.023). Stratified analysis demonstrated that ICG did not significantly improve the surgical outcomes in simple cases (n = 208). On the other hand, in difficult cases (n = 228), NIRFC shortened operative time (P = 0.003) and length of stay (P = 0.015), reduced blood loss (P = 0.028) and drain placement rate (P = 0.015), and had fewer adverse reactions (P = 0.023). The data showed that five cases were converted to laparotomy while two cases had minor bile leaks in the non-ICG group. There was no bile duct injury (BDI) in all the cases. Furthermore, high BMI, history of urgent admission and abdominal surgery, palpable gallbladder, thickened wall, and pericholecystic collection were risk factors for surgical difficulty.

Conclusion

ICG-assisted NIRFC provides real-time biliary visualization. In complicated conditions such as acute severe inflammation, dense adhesions, and biliary variants, the navigating ability of fluorescence can enhance the operation progress, reduce the possibility of conversion or serious complications, and improve the efficiency and safety of difficult LC.

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Funding

This work was supported by the National Natural Science Foundation of China (32170717) and the Grant from the National Key Research and Development Program of China (SQ2019YFC200078/02).

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Author notes

  1. Chengfan Xu and Maohui Yin have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary & Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People’s Republic of China

    Chengfan Xu, Maohui Yin, Haitao Wang, Ping Jiang, Zhiyong Yang, Yueming He, Zhonglin Zhang, Zhisu Liu, Bo Liao & Yufeng Yuan

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  1. Chengfan Xu
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This manuscript was written by all the authors, who gave approval of the final version of the manuscript. Chengfan Xu and Maohui Yin contributed equally to the manuscript.

Corresponding authors

Correspondence to Zhisu Liu, Bo Liao or Yufeng Yuan.

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Chengfan Xu, Maohui Yin, Haitao Wang, Ping Jiang, Zhiyong Yang, Yueming He, Zhonglin Zhang, Zhisu Liu, Bo Liao, and Yufeng Yuan have no conflict of interest or financial ties to disclose.

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Xu, C., Yin, M., Wang, H. et al. Indocyanine green fluorescent cholangiography improves the clinical effects of difficult laparoscopic cholecystectomy. Surg Endosc 37, 5836–5846 (2023). https://doi.org/10.1007/s00464-023-10035-8

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  • DOI: https://doi.org/10.1007/s00464-023-10035-8

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