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Fluorescence-Guided Surgery of the Biliary Tree Utilizing Indocyanine Green (ICG)

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Abstract

Laparoscopic cholecystectomy (LC) is the most common elective abdominal surgery in the United States, with over 750,000 performed annually. Fluorescent cholangiography (FC) using indocyanine green dye (ICG) permits identification of extrahepatic biliary structures to facilitate dissection without requiring biliary tree cannulation with intraoperative cholangiogram (IOC). Literature review and analysis of our institutional data shows fluorescence cholangiography used in conjunction with the “critical view of safety” is a noninvasive adjunct to laparoscopic cholecystectomy with improved patient outcomes. These findings support ICG as standard of care during laparoscopic cholecystectomy.

Keywords

  • ICG
  • Indocyanine green
  • Fluorescence-guided surgery
  • Cholecystectomy
  • Minimally invasive surgery
  • Laparoscopic cholecystectomy

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References

  1. Steiner C, Karaca Z, Moore B, Imshaug M, Pickens G. Surgeries in hospital-based ambulatory surgery and hospital inpatient settings, 2014. HCUP Stat Br #223. 2017.

    Google Scholar 

  2. Kohn JF, Trenk A, Kuchta K, et al. Characterization of common bile duct injury after laparoscopic cholecystectomy in a high-volume hospital system. Surg Endosc. 2018. https://doi.org/10.1007/s00464-017-5790-8.

  3. van de Graaf FW, Zaïmi I, Stassen LPS, Lange JF. Safe laparoscopic cholecystectomy: a systematic review of bile duct injury prevention. Int J Surg. 2018. https://doi.org/10.1016/j.ijsu.2018.11.006.

  4. Tayeb M, Raza SA, Khan MR, Azami R. Conversion from laparoscopic to open cholecystectomy: multivariate analysis of preoperative risk factors. J Postgrad Med. 2005;51:17–20.

    Google Scholar 

  5. Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg. 1993;165(1):9–14. https://doi.org/10.1016/S0002-9610(05)80397-6.

    CAS  CrossRef  PubMed  Google Scholar 

  6. Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA. 2003;290(16):2168–73. https://doi.org/10.1001/jama.290.16.2168.

    CAS  CrossRef  PubMed  Google Scholar 

  7. Dolan JP, Diggs BS, Sheppard BC, Hunter JG. Ten-year trend in the national volume of bile duct injuries requiring operative repair. Surg Endosc Other Interv Tech. 2005;19(7):967–73. https://doi.org/10.1007/s00464-004-8942-6.

    CAS  CrossRef  Google Scholar 

  8. Halbert C, Pagkratis S, Yang J, et al. Beyond the learning curve: incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era. Surg Endosc. 2016;30(6):2239–43. https://doi.org/10.1007/s00464-015-4485-2.

    CrossRef  PubMed  Google Scholar 

  9. Rydbeck D, Anesten B, Barje T, Hajnal P, Österberg J, Sandblom G. Health-related quality-of-life in a cohort undergoing cholecystectomy. Ann Med Surg. 2015;4(1):22–5. https://doi.org/10.1016/j.amsu.2014.11.002.

    CrossRef  Google Scholar 

  10. Mangieri CW, Hendren BP, Strode MA, Bandera BC, Faler BJ. Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era. Surg Endosc. 2019. https://doi.org/10.1007/s00464-018-6333-7.

  11. Costantini R, Caldaralo F, Palmieri C, et al. Risk factors for conversion of laparoscopic cholecystectomy. Ann Ital Chir. 2012;83(3):245–52. https://doi.org/10.1097/00013644-200212000-00023.

    CrossRef  PubMed  Google Scholar 

  12. Rattner DW, Ferguson C, Warshaw AL. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1993;217(3):233–6. https://doi.org/10.1097/00000658-199303000-00003.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  13. Kama NA, Doganay M, Dolapci M, Reis E, Atli M, Kologlu M. Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc. 2001;15(9):965–8. https://doi.org/10.1007/s00464-001-0008-4.

    CAS  CrossRef  PubMed  Google Scholar 

  14. Lengyel BI, Panizales MT, Steinberg J, Ashley SW, Tavakkoli A. Laparoscopic cholecystectomy: what is the price of conversion? Surgery (United States). 2012;152(2):173–8. https://doi.org/10.1016/j.surg.2012.02.016.

    CrossRef  Google Scholar 

  15. Savader SJ, Lillemoe KD, Prescott CA, et al. Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster. Ann Surg. 1997. https://doi.org/10.1097/00000658-199703000-0000.

  16. de Reuver PR, Sprangers MAG, Rauws EAJ, et al. Impact of bile duct injury after laparoscopic cholecystectomy on quality of life: a longitudinal study after multidisciplinary treatment. Endoscopy. 2008. https://doi.org/10.1055/s-2008-1077444.

  17. Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995;180:101–25.

    CAS  PubMed  Google Scholar 

  18. Aziz H, Pandit V, Joseph B, Jie T, Ong E. Age and obesity are independent predictors of bile duct injuries in patients undergoing laparoscopic cholecystectomy. World J Surg. 2015. https://doi.org/10.1007/s00268-015-3010-z.

  19. Buddingh KT, Nieuwenhuijs VB, Van Buuren L, Hulscher JBF, De Jong JS, Van Dam GM. Intraoperative assessment of biliary anatomy for prevention of bile duct injury: a review of current and future patient safety interventions. Surg Endosc. 2011. https://doi.org/10.1007/s00464-011-1639-8.

  20. Rystedt JML, Tingstedt B, Montgomery F, Montgomery AK. Routine intraoperative cholangiography during cholecystectomy is a cost-effective approach when analysing the cost of iatrogenic bile duct injuries. HPB. 2017. https://doi.org/10.1016/j.hpb.2017.06.004.

  21. Ishizawa T, Bandai Y, Ijichi M, Kaneko J, Hasegawa K, Kokudo N. Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy. Br J Surg. 2010. https://doi.org/10.1002/bjs.7125.

  22. Dip FD, Asbun D, Rosales-Velderrain A, et al. Cost analysis and effectiveness comparing the routine use of intraoperative fluorescent cholangiography with fluoroscopic cholangiogram in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2014. https://doi.org/10.1007/s00464-013-3394-5.

  23. Stefanidis D, Chintalapudi N, Anderson-Montoya B, Oommen B, Tobben D, Pimentel M. How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy? Surg Endosc. 2017. https://doi.org/10.1007/s00464-016-4943-5.

  24. Oddi A, Di Nicola V, Panzini A, et al. The intraoperative visualization of the bile ducts by the use of fluorescent substances. A feasibility study. G Chir. 1996;17:620–3.

    CAS  PubMed  Google Scholar 

  25. Hope-Ross M, Yannuzzi LA, Gragoudas ES, et al. Adverse reactions due to indocyanine green. Retina. 1995. https://doi.org/10.1097/00006982-199515010-00022.

  26. Caro JJ, Trindade E, McGregor M. The risks of death and of severe nonfatal reactions with high- vs low-osmolality contrast media: a meta-analysis. Am J Roentgenol. 1991. https://doi.org/10.2214/ajr.156.4.1825900.

  27. Agnus V, Pesce A, Boni L, et al. Fluorescence-based cholangiography: preliminary results from the IHU-IRCAD-EAES EURO-FIGS registry. Surg Endosc. 2020;34(9):3888–96. https://doi.org/10.1007/s00464-019-07157-3.

    CrossRef  PubMed  Google Scholar 

  28. Tagaya N, Shimoda M, Kato M, Nakagawa A, Abe A, Iwasaki Y, et al. Intraoperative exploration of biliary anatomy using fluorescence imaging of indocyanine green in experimental and clinical cholecystectomies. J Hepatobiliary Pancreat Sci. 2010;17(5):595–600.

    CrossRef  Google Scholar 

  29. Ishizawa T, Kaneko J, Inoue Y, et al. Application of fluorescent cholangiography to single-incision laparoscopic cholecystectomy. Surg Endosc. 2011;25:2631–6.

    CrossRef  Google Scholar 

  30. Schols RM, Bouvy ND, Masclee AAM, et al. Fluorescence cholangiography during laparoscopic cholecystectomy: a feasibility study on early biliary tract delineation. Surg Endosc. 2013;27:1530–6.

    CrossRef  Google Scholar 

  31. Tagaya N, Sugamata Y, Makino N, Saito K, Okuyama T, Koketsu S, Oya M. Fluorescence cholangiography in laparoscopic cholecystectomy: experience in Japan. In: Fluorescent imaging, vol. 31. Karger Publishers, Berlin, Germany; 2013. p. 73–9.

    Google Scholar 

  32. Boni L, David G, Mangano A, et al. Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc. 2015;29:2046–55.**

    CrossRef  Google Scholar 

  33. Dip F, Roy M, Menzo EL, Simpfendorfer C, Szomstein S, Rosenthal RJ. Routine use of fluorescent incisionless cholangiography as a new imaging modality during laparoscopic cholecystectomy. Surg Endosc. 2015;29(6):1621–6.

    CrossRef  Google Scholar 

  34. Kono Y, Ishizawa T, Tani K, Harada N, Kaneko J, Saiura A, et al. Techniques of fluorescence cholangiography during laparoscopic cholecystectomy for better delineation of the bile duct anatomy. Medicine. 2015;94(25):e1005.

    CrossRef  Google Scholar 

  35. Osayi SN, Wendling MR, Drosdeck JM, Chaudhry UI, Perry KA, Noria SF, et al. Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy. Surg Endosc. 2015;29(2):368–75.

    CrossRef  Google Scholar 

  36. van Dam DA, Ankersmit M, van de Ven P, van Rijswijk AS, Tuynman JB, Meijerink WJ. Comparing near-infrared imaging with indocyanine green to conventional imaging during laparoscopic cholecystectomy: a prospective crossover study. J Laparoendosc Adv Surg Tech A. 2015;25(6):486–92.

    CrossRef  Google Scholar 

  37. Igami T, Nojiri M, Shinohara K, Ebata T, Yokoyama Y, Sugawara G, et al. Clinical value and pitfalls of fluorescent cholangiography during single-incision laparoscopic cholecystectomy. Surg Today. 2016;46(12):1443–50.

    CrossRef  Google Scholar 

  38. Zroback C, Chow G, Meneghetti A, Warnock G, Meloche M, Chiu CJ, Panton ON. Fluorescent cholangiography in laparoscopic cholecystectomy: the initial Canadian experience. Am J Surg. 2016;211(5):933–7.

    CrossRef  Google Scholar 

  39. Ankersmit M, Van Dam DA, van Rijswijk AS, Van Den Heuvel B, Tuynman JB, Meijerink WJ. Fluorescent imaging with indocyanine green during laparoscopic cholecystectomy in patients at increased risk of bile duct injury. Surg Innov. 2017;24(3):245–52.

    CrossRef  Google Scholar 

  40. Koirala R, Rajbhandari A, Rai P, Gurung TM. Use of intravenous Indocyanine green to delineate biliary tree anatomy and cystic artery anatomy in patients undergoing laparoscopic cholecystectomy. Nepal Med Coll. 2017;19(4):213–6.

    Google Scholar 

  41. Hiwatashi K, Okumura H, Setoyama T, Ando K, Ogura Y, Aridome K, et al. Evaluation of laparoscopic cholecystectomy using indocyanine green cholangiography including cholecystitis: a retrospective study. Medicine. 2018;97(30):e11654.

    CrossRef  Google Scholar 

  42. Pesce A, Latteri S, Barchitta M, Portale TR, Di Stefano B, Agodi A, Russello D, Puleo S, La Greca G. Near-infrared fluorescent cholangiography–real-time visualization of the biliary tree during elective laparoscopic cholecystectomy. HPB. 2018;20(6):538–45.

    CrossRef  Google Scholar 

  43. Tsutsui N, Yoshida M, Nakagawa H, Ito E, Iwase R, Suzuki N, et al. Optimal timing of preoperative indocyanine green administration for fluorescent cholangiography during laparoscopic cholecystectomy using the PINPOINT® Endoscopic Fluorescence Imaging System. Asian J Endosc Surg. 2018;11(3):199–205.

    CrossRef  Google Scholar 

  44. Ambe PC, Plambeck J, Fernandez-Jesberg V, Zarras K. The role of indocyanine green fluoroscopy for intraoperative bile duct visualization during laparoscopic cholecystectomy: an observational cohort study in 70 patients. Patient Saf Surg. 2019. https://doi.org/10.1186/s13037-019-0182-8.

  45. Calabro KA, Harmon CM, Vali K. Indocyanine green use during pediatric laparoscopic cholecystectomy. Videoscopy. 2019. https://doi.org/10.1089/vor.2019.0577.

  46. Dip F, LoMenzo E, Sarotto L, Phillips E, Todeschini H, Nahmod M, Alle L, Schneider S, Kaja L, Boni L, Ferraina P. Randomized trial of near-infrared incisionless fluorescent cholangiography. Ann Surg. 2019;270(6):992–9.

    CrossRef  Google Scholar 

  47. Bleszynski MS, DeGirolamo KM, Meneghetti AT, Chiu CJ, Panton ON. Fluorescent cholangiography in laparoscopic cholecystectomy: an updated Canadian experience. Surg Innov. 2020. https://doi.org/10.1177/1553350619885792.

  48. Quaresima S, Balla A, Palmieri L, et al. Routine near infra-red indocyanine green fluorescent cholangiography versus intraoperative cholangiography during laparoscopic cholecystectomy: a case-matched comparison. Surg Endosc. 2019. https://doi.org/10.1007/s00464-019-06970-0.

  49. Pesce A, La Greca G, Ultimo LE, Basile A, Puleo S, Palmucci S. Effectiveness of near-infrared fluorescent cholangiography in the identification of cystic duct-common hepatic duct anatomy in comparison to magnetic resonance cholangio-pancreatography: a preliminary study. Surg Endosc. 2020;34(6):2715–21.

    Google Scholar 

  50. Yoshiya S, Minagawa R, Kamo K, et al. Usability of intraoperative fluorescence imaging with indocyanine green during laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. World J Surg. 2019. https://doi.org/10.1007/s00268-018-4760-1.

  51. Keeratibharat N, Chansangrat J. Intra-operative fluorescent cholangiography during laparoscopic cholecystectomy; initial experience of single surgeon. HPB. 2019;21:S472.

    CrossRef  Google Scholar 

  52. Esposito C, Corcione F, Settimi A, et al. Twenty-five year experience with laparoscopic cholecystectomy in the pediatric population-from 10 mm clips to indocyanine green fluorescence technology: long-term results and technical considerations. J Laparoendosc Adv Surg Tech A. 2019. https://doi.org/10.1089/lap.2019.0254.

  53. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010. https://doi.org/10.1016/j.jamcollsurg.2010.02.053.

  54. Vlek SL, van Dam DA, Rubinstein SM, et al. Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review. Surg Endosc. 2017. https://doi.org/10.1007/s00464-016-5318-7.

  55. Dolan JP, Diggs BS, Sheppard BC, Hunter JG. The national mortality burden and significant factors associated with open and laparoscopic cholecystectomy: 1997–2006. J Gastrointest Surg. 2009;13(12):2292–301. https://doi.org/10.1007/s11605-009-0988-2.

    CrossRef  PubMed  Google Scholar 

  56. Pucher PH, Brunt LM, Davies N, et al. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc. 2018. https://doi.org/10.1007/s00464-017-5974-2.

  57. Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. JAMA Surg. 2018. https://doi.org/10.1001/jamasurg.2017.6233.

  58. Ahmad A. Use of indocyanine green (ICG) augmented near-infrared fluorescence imaging in robotic radical resection of gallbladder adenocarcinomas. Surg Endosc. 2020;34(6):2490–4. https://doi.org/10.1007/s00464-019-07053-w.

    CrossRef  PubMed  Google Scholar 

  59. Hutteman M, van der Vorst JR, Mieog JS, et al. Near-infrared fluorescence imaging in patients undergoing pancreaticoduodenectomy. Eur Surg Res. 2011;47(2):90–7. https://doi.org/10.1159/000329411.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

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Broderick, R.C., Reeves, J., Horgan, S. (2021). Fluorescence-Guided Surgery of the Biliary Tree Utilizing Indocyanine Green (ICG). In: Horgan, S., Fuchs, KH. (eds) Innovative Endoscopic and Surgical Technology in the GI Tract . Springer, Cham. https://doi.org/10.1007/978-3-030-78217-7_33

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