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Lim YZ, Mutore K, Bradd MV, Pandya S, Corbitt N. A Pilot Study for Biliary Atresia Diagnosis: Fluorescent Imaging of Indocyanine Green in Stool. J Pediatr Surg 2024; 59:1362-1368. [PMID: 38614948 DOI: 10.1016/j.jpedsurg.2024.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Biliary atresia is the most common cause of obstructive jaundice in infants and conventional cholangiography is the current diagnostic gold standard. Fluorescent cholangiography with indocyanine green can enhance biliary tree visualization during surgery because it is exclusively excreted into the bile ducts and eventually into the intestine. Therefore, we hypothesized that indocyanine green presence in stool could confirm bile duct patency in infants. METHODS A prospective single center cohort study was performed on infants (age ≤ 12 months) with and without jaundice after obtaining IRB approval. Indocyanine green was administered intravenously (0.1 mg/kg). Soiled diapers collected post-injection were imaged for fluorescence. RESULTS After indocyanine green administration, fluorescence was detected in soiled diapers for control patients (n = 4, x = 14 h22 m post-injection) and jaundiced patients without biliary atresia (n = 11, x = 13 h28 m post-injection). For biliary atresia patients (n = 7), post-injection soiled diapers before and after Kasai portoenterostomy were collected. Fluorescence was not detected in stool from 6 of 7 biliary atresia patients. As a test, indocyanine green detection in stool was 97% accurate for assessing biliary patency. CONCLUSION Fluorescent Imaging for Indocyanine Green (FIInd Green) in stool is a fast and accurate approach to assess biliary patency non-invasively in infants. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yi Zou Lim
- Children's Research Institute at UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Kevin Mutore
- Department of Surgery, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Maria Valencia Bradd
- Department of Surgery, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Samir Pandya
- Division of Pediatric Surgery, UT Southwestern Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX 75235, USA
| | - Natasha Corbitt
- Division of Pediatric Surgery, UT Southwestern Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX 75235, USA.
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Delgado-Miguel C, Camps J, Hernandez Oliveros F. The Role of Indocyanine Green in Pediatric Gastrointestinal Surgery: Systematic Review. Eur J Pediatr Surg 2024; 34:2-8. [PMID: 37406677 DOI: 10.1055/a-2123-5433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
The use of near-infrared fluorescence imaging with indocyanine green (ICG) is actually considered as a very useful tool in decision-making strategy during challenging surgical procedures with a growing evidence in the literature. Our aim is to perform a systematic review focusing on ICG applications in gastrointestinal surgery. We conducted a systematic review with narrative synthesis in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Medline, and EMBASE databases to identify articles describing the gastrointestinal perioperative use of ICG in children. We extracted data on study design, demographics, surgical indications, ICG dose, and perioperative outcomes. Eleven articles, including 94 pediatric patients, from 2013 to 2022 met the inclusion criteria for narrative synthesis in our systematic review, of which 6/11 (54.5%) were case reports, 4/11 (36.4%) were retrospective studies, and 1/11 (0.1%) were case series. Current clinical applications of ICG in gastrointestinal pediatric surgery included: esophagogastric surgery in 4/11 articles (36.4%), intestinal and pancreatic surgery in 3/11 articles (27.2%), and colorectal surgery in 4/11 articles (36.4%). ICG fluorescence in gastrointestinal pediatric surgery is a promising and safe technology that facilitates intraoperative localization of anatomical structures to achieve a more precise dissection and avoid injury to other adjacent tissues. It can be considered as a meaningful tool for assessing intestinal viability, as it provides objective data on tissue perfusion, and can impact the intraoperative decision in reconstructive surgeries requiring anastomosis. Future studies are needed to confirm these initial promising results. The lack of comparative and prospective studies is still the main limitation.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, United States
| | - Juan Camps
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, United States
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Esposito C, Rathod KJ, Cerulo M, Del Conte F, Saxena R, Coppola V, Sinha A, Esposito G, Escolino M. Indocyanine green fluorescent cholangiography: The new standard practice to perform laparoscopic cholecystectomy in pediatric patients. A comparative study with conventional laparoscopic technique. Surgery 2024; 175:498-504. [PMID: 38007385 DOI: 10.1016/j.surg.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/01/2023] [Accepted: 10/25/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND This study aimed to compare outcomes of standard laparoscopic cholecystectomy and indocyanine green fluorescent cholangiography laparoscopic cholecystectomy over a 10-year period. METHODS From 2013 to 2023, 173 laparoscopic cholecystectomies were performed in 2 pediatric surgery units: 83 using standard technique (G1) and 90 using indocyanine green fluorescent cholangiography (G2). Patients included 96 girls and 77 boys, with a median age of 12.3 years (range 4-17) and a median weight of 51 kg (range 19-114). The 2 groups were compared regarding the following: (1) perioperative complications rate; (2) overall length of surgery (T1); (3) length of cystic duct isolation, clipping, and sectioning (T2); (4) time of gallbladder removal (T3); (5) degree of visualization of biliary tree; (6) safety and feasibility of indocyanine green fluorescent cholangiography; (7) incidence of anatomical anomalies detected intraoperatively. RESULTS All laparoscopic cholecystectomies were accomplished without conversion to open. The perioperative complications rate was significantly higher in G1 compared with G2 (12% vs 0%; P = .0007). Median T1, T2, and T3 were significantly longer in G1 (90, 37, 35 minutes) compared with G2 (55, 17, 19 minutes) (P = .0001), respectively. The visualization rate of the complete biliary tree was significantly higher in G2 (98.8%) than in G1 (80.7%) (P = .0001). No adverse reactions to indocyanine green were recorded. The incidence of biliary anomalies detected intraoperatively was significantly higher in G2 (7.8%) than in G1 (1.2%) (P = .03). CONCLUSION Indocyanine green fluorescent cholangiography can be considered the new standard practice to perform laparoscopic cholecystectomy in pediatrics. Indocyanine green fluorescence provided superior visualization of biliary anatomy, increased detection of anatomic variants, faster procedure, and fewer complications compared with conventional technique. Indocyanine green fluorescent cholangiography was safe, feasible, simple, inexpensive, and a timesaving tool.
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Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy.
| | - Kirtikumar J Rathod
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mariapina Cerulo
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Fulvia Del Conte
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Rahul Saxena
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vincenzo Coppola
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Maria Escolino
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
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Preziosi A, Paraboschi I, Giuliani S. Evaluating the Development Status of Fluorescence-Guided Surgery (FGS) in Pediatric Surgery Using the Idea, Development, Exploration, Assessment, and Long-Term Study (IDEAL) Framework. CHILDREN 2023; 10:children10040689. [PMID: 37189938 DOI: 10.3390/children10040689] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
Fluorescence-guided surgery (FGS) is used in many pediatric subspecialties but there are currently no standard guidelines or outcome data. We aimed to assess the current status of FGS in pediatrics using the Idea, Development, Exploration, Assessment, and Long-term study (IDEAL) framework. Clinical papers on FGS in children published from January 2000 to December 2022 were systematically reviewed. The stage of research development was measured considering seven fields of application: biliary tree imaging, vascular perfusion for gastrointestinal procedures, lymphatic flow imaging, tumor resection, urogenital surgery, plastic surgery, and miscellaneous procedures. Fifty-nine articles were selected. For each field of application, the overall IDEAL stage was determined to be 2a for biliary tree imaging (10 publications, 102 cases), 1 for vascular perfusion for gastrointestinal procedures (8 publications, 28 cases), 1 for lymphatic flow imaging (12 publications, 33 cases), 2a for tumor resection (20 publications, 238 cases), 2a for urogenital surgery (9 publications, 197 cases), and 1-2a for plastic surgery (4 publications, 26 cases). One report did not belong to any categories. FGS in children is still in an early phase of adoption and development. We recommend using the IDEAL framework as a guide and suggest developing multicenter studies to define the standard guidelines, effectiveness, and outcomes.
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Affiliation(s)
- Alessandra Preziosi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milano, Italy
- Cancer Section, Developmental Biology and Cancer Programme, UCL, Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Irene Paraboschi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milano, Italy
- Cancer Section, Developmental Biology and Cancer Programme, UCL, Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Stefano Giuliani
- Cancer Section, Developmental Biology and Cancer Programme, UCL, Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London W1W 7TY, UK
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Fluorescence-guided surgery: National trends in adoption and application in pediatric surgery. J Pediatr Surg 2023; 58:689-694. [PMID: 36670001 DOI: 10.1016/j.jpedsurg.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Fluorescence-guided surgery (FGS) with indocyanine green (ICG) is a rapidly diffusing surgical innovation, but its utilization in pediatrics remains unknown. We present a cross-sectional descriptive analysis of trends from a national database. METHODS The Pediatric Health Information System (PHIS) database was queried for patient encounters between January 2016 and July 2021 with an associated ICG administration within 3 days prior to surgery. All procedure codes from each encounter were reviewed by two surgeons to determine the most likely associated FGS procedure and assign an operative category. RESULTS 1270 encounters were identified from 38 participating hospitals. The mean patient age (SD) was 8.3 (6.4) years, 54.5% were male, 63.8% were white, and 30.1% were Hispanic. The most common categories for ICG use were neurosurgery (21.3%), biliary (18.3%), perfusion (14.8%), urology (12.5%), gastrointestinal (10.8%), ophthalmology (8.8%), and thoracic (5.6%). Utilization over time increased for some categories (thoracic, visceral perfusion, and neurological procedures) or remained stable for other categories. Overall ICG utilization has increased in 2020 (n = 314) compared to 2016 (N = 83). The number of centers utilizing ICG has also increased from 14 hospitals in 2016 to 29 hospitals in 2020 though adoption remains unevenly distributed, with 5 high-utilization hospitals accounting for 56.8% of all ICG FGS cases. CONCLUSION ICG is being used across a wide variety of pediatric surgical disciplines. Trends over time show increasingly frequent adoption across the country, with a few high-volume centers driving the innovation. Fluorescence-guided surgery is commercially available and is becoming more commonplace for pediatric surgeons. Dedicated efforts will now be needed to assess outcomes using this promising technology. LEVEL OF EVIDENCE Level IV. STUDY TYPE Retrospective study.
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Esposito C, Borgogni R, Autorino G, Cerulo M, Carulli R, Esposito G, Del Conte F, Escolino M. Applications of Indocyanine Green-Guided Near-Infrared Fluorescence Imaging in Pediatric Minimally Invasive Surgery Urology: A Narrative Review. J Laparoendosc Adv Surg Tech A 2022; 32:1280-1287. [PMID: 36450121 DOI: 10.1089/lap.2022.0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Indocyanine green (ICG) is a fluorescent dye used for several indications in adult surgery, and, more recently, adopted also in the pediatric patients. This study aimed to review the literature published on the use of ICG near-infrared fluorescence (NIRF) in pediatric urology, to address its shortcomings and disadvantages and to detect the future perspectives. Materials and Methods: An electronic literature search of PubMed on all studies reporting use of ICG-NIRF in pediatrics was performed. We included only studies reporting ICG-NIRF application in minimally invasive surgery (MIS) for pediatric urology indications. Results: Forty-two articles reporting MIS procedures performed using ICG-NIRF in children were obtained, but only 15 studies that focused on urological applications of ICG-NIRF in children were included in this review. The included studies described use of ICG-NIRF for kidney malformations such as duplex system, kidney tumors, renal cysts, ureteral pathology, bladder malformations, varicocele, and lymph node sampling in tumors. The pediatric urological applications in which ICG-NIRF provided significant advantages included partial nephrectomy, lymphatics sparing varicocele repair, and oncological procedures. The ICG-NIRF use was clinically safe, without reported adverse systemic reactions in all pediatric series. The main drawback of this technology is the need of specific laparoscopic equipment such as camera system, light sources, and telescopes or the da Vinci Xi Robot, with the software for ICG-NIRF, Firefly®, already integrated within. Conclusions: ICG-enhanced fluorescence-guided surgery is gaining growing popularity among pediatric surgeons due to the excellent results that have been published until now. ICG-NIRF technology has proven to be safe, easy to use, not time-consuming, cheap, and very effective to improve intraoperative view and surgical ability. Nonetheless, further evidence, including larger series, longer follow-up, and more specific assessments, is necessary to confirm the preliminary results and enlarge the applications.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Rachele Borgogni
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Giuseppe Autorino
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Mariapina Cerulo
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Roberto Carulli
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biotechnologies, CEINGE, Center of Advanced Biotechnologies, Naples, Italy
| | - Fulvia Del Conte
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
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7
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Using indocyanine green fluorescence in laparoscopic surgery to identify and preserve rare branching of the right hepatic artery in pediatric congenital biliary dilatation. Surg Today 2022; 52:1510-1513. [DOI: 10.1007/s00595-022-02516-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
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Zhao Y, Tao H, Liu Y, Sha G, Yi X, Qin Q, Jin D, He C, Wu X, Zhou Q. Effectiveness and Clinical Value of Laparoscopic Cholecystectomy and Cholangiography in the Diagnosis of Biliary Calculi. Front Surg 2022; 9:880266. [PMID: 35574533 PMCID: PMC9091961 DOI: 10.3389/fsurg.2022.880266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the effectiveness and clinical value of cholangiography in the diagnosis of bile duct stones in laparoscopic cholecystectomy. Methods 200 patients who underwent laparoscopic cholecystectomy in our hospital from January 2017 to January 2019 were randomly divided into research group and control group, with 100 cases in each group. The research group underwent choledochotomy and exploration with the help of choledochoscope, while the control group underwent cholangiography to diagnose bile duct stones. The cure rate, residual stone rate, complication rate, intraoperative bleeding, hospital stay and patient satisfaction were compared between the two groups. Results in the control group, 9 cases were converted to laparotomy, 20 cases of common bile duct stones, 10 cases of bile duct injury and 6 cases of common bile duct variation. In the research group, there were 2 cases of conversion to laparotomy, 12 cases of common bile duct stones, 2 cases of bile duct injury and 4 cases of common bile duct variation. The cure rate of the researchgroup was higher than that of the control group, There was significant difference between the two groups (P < 0.05). The residual amount of stones in the research group was lower than that in the control group, and there was significant difference between the two groups (P < 0.05). The incidence of postoperative complications in the research group was lower than that in the control group, and there was significant difference between the two groups (P < 0.05). The patient satisfaction in the research group was higher than that in the control group, and there was significant difference between the two groups (P < 0.05). The intraoperative blood output of the research group was lower than that of the observation group, and there was significant difference between the two groups (P < 0.05). Conclusion cholangiography is an effective method for the diagnosis of bile duct stones in laparoscopic cholecystectomy. Clarifying the variation and anatomical structure of bile duct is helpful to improve the surgical cure rate, reduce the residual rate of postoperative stones and the incidence of complications, reduce the amount of intraoperative bleeding, shorten the hospital stay, and promote the postoperative rehabilitation of patients.
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Affiliation(s)
- Yunqing Zhao
- Department of General Surgery, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Hongbo Tao
- Department of Anesthesiology, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Yanqin Liu
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
- *Correspondence: Yanqin Liu
| | - Gen Sha
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
- Gen Sha
| | - Xianyun Yi
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Qin Qin
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Dong Jin
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Chengjie He
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Xianghong Wu
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Qing Zhou
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
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Esposito C, Escolino M. Re: "Fluorescent Cholangiography in Laparoscopic Cholecystectomy and the Use in Pediatric Patients" by Calabro et al. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34958253 DOI: 10.1089/lap.2021.0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Maria Escolino
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
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10
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Efficacy of indocyanine green (ICG) fluorescent cholangiography to improve intra-operative visualization during laparoscopic cholecystectomy in pediatric patients: a comparative study between ICG-guided fluorescence and standard technique. Surg Endosc 2021; 36:4369-4375. [PMID: 34734300 DOI: 10.1007/s00464-021-08784-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In the last few years, indocyanine green (ICG) fluorescent cholangiography (FC) has been adopted to perform intra-operative biliary mapping during laparoscopic cholecystectomy (LC). This study aimed to compare the results of LC with and without use of ICG-FC. METHODS All LC operated from June 2017 to June 2021 in our unit were retrospectively reviewed. Pre-operative workup included ultrasonography to assess dilation of main biliary tree. The ICG dosage was 0.35 mg/kg and the median timing of administration was 15.5 h pre-operatively. We evaluated, analyzing videorecorded procedures, 3 parameters in both groups: the total operative time (T1), the time of cystic duct isolation, clipping and sectioning (T2), and the time of gallbladder removal from hepatic fossa (T3). RESULTS Forty-three LC were operated in the study period: 22 using standard technique (G1) and 21 using ICG-FC (G2). There were 27 girls and 16 boys, with median age at surgery of 11.5 years (range 7-17) and median weight of 47 kg (range 31-110). No conversions were reported in our series. In all ICG cases (except one patient under therapy with phenobarbital) the biliary tree was perfectly visualized during dissection. Intra-operative complications occurred in 3 G1 patients (13.6%): 2 bleedings from the Calot's triangle and 1 bleeding from the liver bed during the gallbladder removal. LC was significantly faster in G2 than in G1 (p = 0.001). In fact, the parameters analyzed (T1, T2, T3) were all significantly greater in G1 than in G2 (p = 0.001). CONCLUSIONS Based upon our experience, we strongly recommend the use of ICG-FC in all pediatric patients undergoing LC. ICG-guided fluorescence provided an excellent real-time visualization of the extrahepatic biliary tree and allowed faster and safer dissection, minimizing the risk of bile duct injuries. Furthermore, ICG use was clinically safe, with no adverse reactions to the product.
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Esposito C, Alberti D, Settimi A, Pecorelli S, Boroni G, Montanaro B, Escolino M. Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA™ technology: preliminary experience in two pediatric surgery centers. Surg Endosc 2021; 35:6366-6373. [PMID: 34231069 PMCID: PMC8523512 DOI: 10.1007/s00464-021-08596-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
Background Recently, we reported the feasibility of indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging to identify extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC) in pediatric patients. This paper aimed to describe the use of a new technology, RUBINA™, to perform intra-operative ICG fluorescent cholangiography (FC) in pediatric LC. Methods During the last year, ICG-FC was performed during LC using the new technology RUBINA™ in two pediatric surgery units. The ICG dosage was 0.35 mg/Kg and the median timing of administration was 15.6 h prior to surgery. Patient baseline, intra-operative details, rate of biliary anatomy identification, utilization ease, and surgical outcomes were assessed. Results Thirteen patients (11 girls), with median age at surgery of 12.9 years, underwent LC using the new RUBINA™ technology. Six patients (46.1%) had associated comorbidities and five (38.5%) were practicing drug therapy. Pre-operative workup included ultrasound (n = 13) and cholangio-MRI (n = 5), excluding biliary and/or vascular anatomical anomalies. One patient needed conversion to open surgery and was excluded from the study. The median operative time was 96.9 min (range 55–180). Technical failure of intra-operative ICG-NIRF visualization occurred in 2/12 patients (16.7%). In the other cases, ICG-NIRF allowed to identify biliary/vascular anatomic anomalies in 4/12 (33.3%), including Moynihan's hump of the right hepatic artery (n = 1), supravescicular bile duct (n = 1), and short cystic duct (n = 2). No allergic or adverse reactions to ICG, post-operative complications, or reoperations were reported. Conclusion Our preliminary experience suggested that the new RUBINA™ technology was very effective to perform ICG-FC during LC in pediatric patients. The advantages of this technology include the possibility to overlay the ICG-NIRF data onto the standard white light image and provide surgeons a constant fluorescence imaging of the target anatomy to assess position of critical biliary structures or presence of anatomical anomalies and safely perform the operation. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08596-7.
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Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Daniele Alberti
- Division of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Settimi
- Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Silvia Pecorelli
- Division of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
| | - Giovanni Boroni
- Division of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
| | | | - Maria Escolino
- Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
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Ida Bagus B, Ida Bagus M, Ida Ayu S. Bismuth Classification of Bile Duct Injury and Its Association with Increasing 30 Days Mortality after Revision Surgery. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The incidence rate of bile duct injury has not been changed for many years for both open or laparoscopic technique. Open cholecystectomy has risen from 0.5% to 1.4% when gallbladder removal is performed laparoscopically. Injuries of the bile duct system after laparoscopic cholecystectomy are more complex than that after an open approach, causing significant morbidity and even death. From initial classification published by Bismuth, there have been many classifications of common bile duct injury. We would reported the 30 days mortality rate following reconstruction after bile duct injury according to type of Bismuth classification.
Case Report: 7 cases of common bile duct injury were reported from 2016 until 2018 following cholecystectomy (both open and laparoscopic), all cases were diagnosed as early complication and without intra operative cholangiography performed. The most common bile duct injury was Bismuth type II and IV (2 patients in each type). Reconstruction has been done by hepatico jejunostomy for type III and IV. Choledoco Duodenostomy bypass was done for type I and II. 2 patients with bismuth type IV have long standing cholangitis and cannot survive during 30 days of follow up. 4 others patients could survive with no intra abdominal complication nor other morbidity.
Conclusion: Bismuth classification was the simpliest type to described the bile duct injury, Bismuth type IV was associated with the high risk of 30 days mortality rate.
Keywords: bismuth classification, bile duct injury, cholecystectomy, mortality
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Le-Nguyen A, O'Neill Trudeau M, Dodin P, Keezer MR, Faure C, Piché N. The Use of Indocyanine Green Fluorescence Angiography in Pediatric Surgery: A Systematic Review and Narrative Analysis. Front Pediatr 2021; 9:736242. [PMID: 34589458 PMCID: PMC8473799 DOI: 10.3389/fped.2021.736242] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/18/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose: Indocyanine green fluorescence angiography (ICG-FA) is a validated non-invasive imaging technique used to assess tissue vascularization and guide intraoperative decisions in many surgical fields including plastic surgery, neurosurgery, and general surgery. While this technology is well-established in adult surgery, it remains sparsely used in pediatric surgery. Our aim was to systematically review and provide an overview of all available evidence on the perioperative use of indocyanine green fluorescence angiography in pediatric surgical patients. Methods: We conducted a systematic review with narrative synthesis in conformity with the PRISMA guidelines using PubMed, Medline, All EBM Reviews, EMBASE, PsycINFO, and CINAHL COMPLETE databases to identify articles describing the perioperative use of ICG-FA in pediatric patients. Two independent authors screened all included articles for eligibility and inclusion criteria. We extracted data on study design, demographics, surgical indications, indocyanine green dose, and perioperative outcomes. We developed a risk of bias assessment tool to evaluate the methodological quality of included studies. Results: Of 1,031 articles retrieved, a total of 64 articles published between 2003 and 2020 were included reporting on 664 pediatric patients. Most articles were case reports and case series (n = 36; 56%). No adverse events related to ICG-FA were reported in the included articles. Risk of bias was high. We did not conduct a meta-analysis given the heterogeneous nature of the populations, interventions, and outcome measures. A narrative synthesis is presented. Conclusion: Indocyanine green fluorescence angiography is a safe imaging technology and its use is increasing rapidly in pediatric surgical specialties. However, the quality of evidence supporting this trend currently appears low. Case-control and randomized trials are needed to determine the adequate pediatric dose and to confirm the potential benefits of ICG-FA in pediatric surgical patients. Systematic Review Registration: This study was registered on Prospero a priori, identifier: CRD42020151981.
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Affiliation(s)
- Annie Le-Nguyen
- Department of General Surgery, Université de Montréal, Montréal, QC, Canada
| | - Maeve O'Neill Trudeau
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Philippe Dodin
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Mark R Keezer
- Department of Neurosciences, Université de Montréal, Montréal, QC, Canada.,Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Christophe Faure
- Department of Gastroenterology, Hepatology, and Nutrition, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Nelson Piché
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
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