Image-guided laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography: what is the optimal time of administration?

Abstract

Introduction

Near-infrared (NIR) fluorescent cholangiography (FC) using indocyanine green (ICG) in laparoscopic cholecystectomy (LC) has been used as a technique for real-time visualization of bile ducts for approximately ten years; however, no standard protocol has been determined. This study aimed to determine the optimal time of administration of ICG.

Material and methods

In this prospective study, patients (n = 30) indicated for LC were divided into two groups. The first group received ICG 1 h before anesthesia at a dose of 0.1 mg/kg (1 h group), whereas the other group received ICG immediately after anesthesia with the same dose (0 h group).

Results

The rates of identification of the cystic duct (CD) and common bile duct (CBD) using NIR FC before and after dissection of Calot’s triangle were comparable between the two groups. The fluorescence intensity ratios of CD/Liver and CBD/Liver were significantly higher in the 1 h group (2.2 vs. 0.49 and 2.1 vs. 0.38, respectively, p < .001) with minimal background liver fluorescence interference in the 1 h group.

Conclusions

The study illustrates that administration of ICG 1 h before surgery with a dose of 0.1 mg/kg allows superior visualization of the extrahepatic bile ducts with minimal fluorescence interference from the background liver.

Keywords:

• Indocyanine green
• near-infrared fluorescence cholangiography
• cholecystectomy
• laparoscopic

Acknowledgments

The authors would like to thank the Egyptian Knowledge Bank for their assistance in the proofreading of the manuscript.

Declaration of interest

The authors of this manuscript have no conflicts of interest to disclose.