Fluorescent image-guided operation using indocyanine green for complex laparoscopic cholecystectomy

Abstract

Abstract Background Laparoscopic cholecystectomy (LC) is a common surgical procedure. Intraoperative fluoroscopic visualisation of the extrahepatic bile duct using indocyanine green (ICG) shows great advantage in LC. However, most studies used small sample sizes and rarely included complex cases, such as acute cholecystitis or reoperation. We analysed the feasibility and safety of using ICG in the complex LC of 70 patients.Methods All patients were administered intravenously with 5 mg of ICG and divided into a long-term group and a short-term group according to the time of administration. The general condition, laboratory results, intraoperative fluorescence visualisation and surgical video of the patients were analysed.Results The two groups showed no significant differences in sex, age, body mass index, American society of anesthesiologists (ASA)score and laboratory results. No significant differences in the rates of gallbladder visualisation (P = 0.622), cystic duct visualisation (P = 0.782) and common bile duct visualisation (P = 0.073). The visualisation of the liver was better in the short-term group (P < 0.001), and the gallbladder bed dissection time (P = 0.026) was better in the short-term group than in the long-term group.Conclusions ICG-assisted complex LC can visualise the bile duct better than the cystic duct. It still has an obvious guiding role in the anatomy of triangulation. The short-term group is better in the visualisation of the liver and in the dissection of the gallbladder from the liver bed. So maybe the short duration of administration is more suitable for patients with complex LC.