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Yoo D. Laparoscopic cholecystectomy for a gallbladder with a right sided round ligament using indocyanine green fluorescence imaging: A case report. Int J Surg Case Rep 2024; 122:110011. [PMID: 39047400 PMCID: PMC11320422 DOI: 10.1016/j.ijscr.2024.110011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION The gallbladder with a right sided round ligament is a rare anomaly. It is frequently associated with various biliary, vascular, and other anomalies. Herein, we present a case of a gallbladder with a right-sided round ligament treated with laparoscopic cholecystectomy using indocyanine green fluorescence imaging. PRESENTATION OF CASE A 50-year-old woman had right upper quadrant discomfort. Gallbladder stones, a polyp, and a right-sided round ligament were found on preoperative computed tomography. Laparoscopic cholecystectomy with indocyanine green fluorescence imaging was decided. During surgery, "fundus first technique" was performed and the biliary anatomy was confirmed with the aid of indocyanine green fluorescence guidance. The gallbladder was attached to segment 4 of the liver which was the left side of the round ligament. Cystic artery and cystic duct were ligated safely. The patient had no postoperative complication. DISCUSSION Although there are various anomalies in patients having a gallbladder with a rights-sided round ligament, ICG fluorescence imaging can show the anatomy of the extrahepatic biliary tree. It can enable surgeons to recognize concomitant vascular and biliary anomalies. CONCLUSION Laparoscopic cholecystectomy for gallbladder with a right-sided round ligament can be safely performed by identifying biliary anatomy with indocyanine green fluorescence imaging.
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Affiliation(s)
- Daegwang Yoo
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Seoul Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea.
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Yoo D. Laparoscopic cholecystectomy for a gallbladder with a short cystic duct draining to the accessory right anterior hepatic duct using indocyanine green fluorescence imaging: A case report. Int J Surg Case Rep 2024; 121:110014. [PMID: 38981297 PMCID: PMC11294690 DOI: 10.1016/j.ijscr.2024.110014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Gallbladder with a short cystic duct draining to the accessory right anterior hepatic duct is a rare variation. It is frequently associated with bile duct injury during laparoscopic cholecystectomy. We present a case of a gallbladder with this variation safely treated with laparoscopic cholecystectomy using indocyanine green (ICG) fluorescence imaging. PRESENTATION OF CASE A 57-year-old man had right upper quadrant pain and showed a gallbladder stone on a preoperative computed tomography. Bile duct anomaly was not detected before operation. However, a short cystic duct draining to the accessory right anterior hepatic duct intraoperatively was found using ICG fluorescence imaging. To confirm the exact anatomy, we firstly detached the gallbladder from the liver with a "fundus first technique" and visualized the whole course of the short cystic duct and the accessory right anterior with ICG fluorescence imaging. Laparoscopic cholecystectomy was completed safely. No bile leakage was detected on ICG fluorescence imaging. The patient had no postoperative complication. DISCUSSION Accessory right hepatic duct is one of the rare variations of bile duct. It can be related to bile duct injury during laparoscopic cholecystectomy. Although it can be injured easily because of its smaller size, we can identify the short cystic duct from it with the aid of ICG fluorescence imaging without injuring the accessory right anterior hepatic duct. CONCLUSION Laparoscopic cholecystectomy for gallbladder with a short cystic duct draining to the accessory right anterior hepatic duct can be safely performed by identifying biliary anatomy with ICG fluorescence imaging.
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Affiliation(s)
- Daegwang Yoo
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Seoul Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea.
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Bhandarkar SD, Kalikar VR, Patankar A, Patankar R. The use of indocyanine green and near-infrared imaging in laparoscopic completion cholecystectomy for the management of stump cholecystitis: A case series. J Minim Access Surg 2024; 20:253-257. [PMID: 37843171 PMCID: PMC11354946 DOI: 10.4103/jmas.jmas_98_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/24/2023] [Accepted: 07/15/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Stump cholecystitis is managed by performing a completion cholecystectomy, which can be done either laparoscopically or by an open method. The use of indocyanine green (ICG) is known to improve the identification of the biliary tree anatomy, facilitating Calot's triangle dissection and shortening surgery, thereby reducing the risk of bile duct injuries and making laparoscopic cholecystectomy safer. PATIENTS AND METHODS A retrospective analysis was performed of prospectively collected data from 15 patients at our institution from March 2016 to March 2021. Magnetic resonance cholangiopancreatography was performed in all 15 cases, showing remnant gall bladder in all cases with calculi within. Four cases had a dilated common bile duct (CBD) with CBD calculi. Endoscopic retrograde cholangiopancreatography (ERCP) and stone removal followed by CBD stenting were performed in the four patients with CBD calculi. These four cases were scheduled for surgery 4 weeks post-ERCP. All 15 patients underwent laparoscopic completion cholecystectomy. The mean operating time was 80 min. RESULTS The post-operative period of all cases was uneventful, and the patients were discharged on post-operative day 2 or day 3. All patients remained asymptomatic during 1-5 years of follow-up. CONCLUSION Laparoscopic completion cholecystectomy was performed safely in cases of stump cholecystitis and resulted in symptom relief during short-term follow-up. The use of ICG and near-infrared imaging in such cases helps identify the biliary anatomy, may contribute to the safety of laparoscopic completion cholecystectomy and might reduce the duration of surgery.
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Affiliation(s)
| | | | - Advait Patankar
- Department of Surgery, Zen Multispeciality Hospital, Chembur, Mumbai, Maharashtra, India
| | - Roy Patankar
- Department of Surgery, Zen Multispeciality Hospital, Chembur, Mumbai, Maharashtra, India
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Symeonidis S, Mantzoros I, Anestiadou E, Ioannidis O, Christidis P, Bitsianis S, Bisbinas V, Zapsalis K, Karastergiou T, Athanasiou D, Apostolidis S, Angelopoulos S. Near-infrared cholangiography with intragallbladder indocyanine green injection in minimally invasive cholecystectomy. World J Gastrointest Surg 2024; 16:1017-1029. [PMID: 38690057 PMCID: PMC11056669 DOI: 10.4240/wjgs.v16.i4.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/02/2024] [Accepted: 03/18/2024] [Indexed: 04/22/2024] Open
Abstract
Laparoscopic cholecystectomy (LC) remains one of the most commonly performed procedures in adult and paediatric populations. Despite the advances made in intraoperative biliary anatomy recognition, iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems. A series of methods have been proposed to prevent bile duct injury, among them the use of indocyanine green (ICG) fluorescence. The most commonly reported method of ICG injection is the intravenous administration, while literature is lacking studies investigating the direct intragallbladder ICG injection. This narrative mini-review aims to assess the potential applications, usefulness, and limitations of intragallbladder ICG fluorescence in LC. Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy, as well as special issues regarding its use. Literature search retrieved four prospective cohort studies, three case-control studies, and one case report. In the three case-control studies selected, intragallbladder near-infrared cholangiography (NIRC) was compared with standard LC under white light, with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography (IOC). In total, 133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC. Literature includes several reports of intragallbladder ICG administration, but a standardized technique has not been established yet. Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping, overwhelming limitations of IOC including intervention and radiation exposure, as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence. Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.
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Affiliation(s)
- Savvas Symeonidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Ioannis Mantzoros
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Elissavet Anestiadou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Panagiotis Christidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stefanos Bitsianis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Vasiliki Bisbinas
- ENT Department, Royal Cornwall Hospitals NHS Trust, Cornwall TR1 3LJ, United Kingdom
| | - Konstantinos Zapsalis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Trigona Karastergiou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Dimitra Athanasiou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stylianos Apostolidis
- 1st Propedeutic Surgical Department, University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Stamatios Angelopoulos
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
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Badawy A, Samer B, Sabra T. Analysis of the sonographic predictors of difficult laparoscopic cholecystectomy in symptomatic cholelithiasis. Asian J Endosc Surg 2024; 17:e13300. [PMID: 38471517 DOI: 10.1111/ases.13300] [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: 01/05/2024] [Revised: 02/19/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is one of the most common laparoscopic procedures performed by young surgeons nowadays. Sometimes, LC could be challenging, especially for junior surgeons leading to serious complications. Therefore, this study aims to investigate the preoperative ultrasonographic features that could predict difficult LC. METHODS In this prospective study, patients (n = 204) who underwent LC for symptomatic cholelithiasis from January 2020 to August 2022 were included. Preoperative parameters, including the ultrasonographic findings, were evaluated for their ability to predict difficult LC. RESULTS The difficulty of LC was evaluated using two intraoperative scores. Among the ultrasonic parameters that were assessed preoperatively, thickened gallbladder (GB) wall, contracted GB, and impacted stone in the GB neck were associated with difficult LC. However, an impacted stone in the GB neck was the only independent predictor of difficult LC according to both difficulty scores in the multivariate analysis (odds ratio [OR] = 7.56, p = .001; OR = 8.42, p = .001). CONCLUSIONS The impacted stone in the GB neck is an ultrasonographic sign of difficult LC. It should alert the surgeon for a more appropriate preoperative preparation, and the patient should be informed about the increased risk of complications, including conversion to open cholecystectomy.
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Affiliation(s)
- Amr Badawy
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Bessa Samer
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek Sabra
- General Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Gupta A, Singh J, Mishra A, Singla SK, Singh RP, Nar AS, Bawa A. Efficacy and outcome of indocyanine green-based intraoperative cholangiography using near-infrared fluorescence imaging: A prospective study. J Minim Access Surg 2024; 20:89-95. [PMID: 38240384 PMCID: PMC10898639 DOI: 10.4103/jmas.jmas_228_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 07/03/2023] [Accepted: 07/15/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION The most dreaded complication during laparoscopic cholecystectomy still remains to be injury to the common bile duct. The primary cause for bile duct injury during LC is misinterpretation of the biliary anatomy. Intra-operative cholangiography was introduced as a means of reducing the chances of biliary injury, done using Fluoroscopic imaging or Near-infrared fluorescence imaging method. NIRF is one of the most popular imaging methods in biomedical sciences. Indocyanine Green is sterile and water soluble which completely binds to albumin and is excreted in bile. PATIENTS AND METHODS This prospective study was conducted among 70 patients between July 2020 and December 2021. Subjects were administered 5mg of ICG dye pre-operatively and procedure performed using Karl Storz HD image S1 system with a D-light P light source for NIRF imaging. RESULTS The average duration of surgery was 58.10 minutes. After calot's dissection, the CBD was visualized in 88.71 % patients, with a mean time to visualization at 26.33 minutes. The cystic duct was visualized in 87.3% cases with a mean time of visualization of 32.10 minutes. The hepatic duct was visualized in 28.57% and the hepatic duct-CBD confluence was visualized in 34.28% patients. CONCLUSION Near infrared imaging based intra-operative cholangiography, using Indocyanine Green dye, during Lap. Cholecystectomy is an easy, useful and inexpensive method of visualizing the biliary ductal anatomy.
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Affiliation(s)
- Anubhavv Gupta
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Jaspal Singh
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Atul Mishra
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sanjeev K. Singla
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ravinder Pal Singh
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Amandeep Singh Nar
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashvind Bawa
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Turner MA, Amirfakhri S, Nishino H, Neel NC, Hosseini M, Cox KE, Lwin TM, Li L, Hong T, Sherman A, Shively JE, Hoffman RM, Yazaki PJ, Bouvet M. PEGylated Fluorescent Anti-carcinoembryonic Antigen Antibody Labels Colorectal Cancer Tumors in Orthotopic Mouse Models. J Surg Res 2023; 291:596-602. [PMID: 37540977 DOI: 10.1016/j.jss.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/29/2023] [Accepted: 06/19/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) patients often develop liver metastasis. However, curative resection of liver metastasis is not always possible due to poor visualization of tumor margins. The present study reports the characterization of a humanized anti-carcinoembryonic antigen monoclonal antibody conjugated to a PEGylated near-infrared dye, that targets and brightly labels human CRC tumors in metastatic orthotopic mouse models. METHODS The hT84.66-M5A (M5A) monoclonal antibody was conjugated with a polyethylene glycol (PEG) chain that incorporated a near infrared (NIR) IR800 dye to establish M5A-IR800 Sidewinder (M5A-IR800-SW). Nude mice with CRC orthotopic primary tumors and liver metastasis both developed from a human CRC cell line, were injected with M5A-IR800-SW and imaged with the Pearl Trilogy Imaging System. RESULTS M5A-IR800-SW targeted and brightly labeled CRC tumors, both in primary-tumor and liver-metastasis models. M5A-IR800-SW at 75 μg exhibited highly-specific tumor labeling in a primary-tumor orthotopic model with a median tumor-to-background ratio of 9.77 and in a liver-metastasis orthotopic model with a median tumor-to-background ratio of 7.23 at 96 h. The precise labeling of the liver metastasis was due to lack of hepatic accumulation of M5A-IR800-SW in the liver. CONCLUSIONS M5A-IR800-SW provided bright and targeted NIR images of human CRC in orthotopic primary-tumor and liver-metastasis mouse models. The results of the present study suggest the clinical potential of M5A-IR800-SW for fluorescence-guided surgery including metastasectomies for CRC. The lack of hepatic NIR signal is of critical importance to allow for precise labeling of liver tumors.
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Affiliation(s)
- Michael A Turner
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, La Jolla, California
| | - Siamak Amirfakhri
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, La Jolla, California
| | - Hiroto Nishino
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, La Jolla, California
| | - Nicholas C Neel
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, California; School of Medicine, University of California San Diego, La Jolla, California
| | - Mojgan Hosseini
- Department of Pathology, School of Medicine, University of California San Diego, La Jolla, California
| | - Kristin E Cox
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, La Jolla, California
| | - Thinzar M Lwin
- Department of Immunology and Theranostics, Beckman Research Institute, City of Hope, Duarte, California
| | - Lin Li
- Department of Immunology and Theranostics, Beckman Research Institute, City of Hope, Duarte, California
| | - Teresa Hong
- Department of Immunology and Theranostics, Beckman Research Institute, City of Hope, Duarte, California
| | - Anakim Sherman
- Department of Immunology and Theranostics, Beckman Research Institute, City of Hope, Duarte, California
| | - John E Shively
- Department of Immunology and Theranostics, Beckman Research Institute, City of Hope, Duarte, California
| | - Robert M Hoffman
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, La Jolla, California; AntiCancer, Inc., San Diego, California
| | - Paul J Yazaki
- Department of Immunology and Theranostics, Beckman Research Institute, City of Hope, Duarte, California
| | - Michael Bouvet
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, La Jolla, California.
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Yoo D. Laparoscopic choledocholithotomy and transductal T-tube insertion with indocyanine green fluorescence imaging and laparoscopic ultrasound: A case report. World J Clin Cases 2023; 11:7193-7199. [PMID: 37946768 PMCID: PMC10631426 DOI: 10.12998/wjcc.v11.i29.7193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Laparoscopic choledocholithotomy for a large impacted common bile duct (CBD) stone is a challenging procedure because of the technical difficulty and the possibility of postoperative complications, even in this era of minimally invasive surgery. Herein, we present a case of large impacted CBD stones. CASE SUMMARY A 71-year-old man showed a distal CBD stone (45 mm × 20 mm) and a middle CBD stone (20 mm × 15 mm) on computed tomography. Endoscopic retrograde cholangiopancreatography failed due to the large size of the impacted stone and the presence of a large duodenal diverticulum. Laparoscopic choledocholithotomy was decided, and we used a near-infrared indocyanine green fluorescence scope to detect and expose the supraduodenal CBD more accurately. Then, the location, size, and shape of the stones were detected using a laparoscopic intraoperative ultrasound. The CBD was opened with a 2-cm-sized vertical incision. After irrigating several times, two CBD stones were removed with the Endo BabcockTM. T-tube insertion was done for postoperative cholangiography and delayed the removal of remnant sludge. The patient had no postoperative complications. CONCLUSION Laparoscopic choledocholithotomy by transcholedochal approach and transductal T-tube insertion is a safe and feasible option for large-sized impacted CBD stones.
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Affiliation(s)
- Daegwang Yoo
- Department of Surgery, Seoul Soonchunhyang University Hospital, Seoul 04401, South Korea
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Rahate NP, Kapse A, Rahate PV, Nimbhorkar SP. The Wonder Dye: Uses and Implications of Indigocyanine Green in Various Surgeries. Cureus 2023; 15:e46722. [PMID: 38021982 PMCID: PMC10630983 DOI: 10.7759/cureus.46722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Indigocyanine green (ICG) is a fluorophore dye that has been extensively used in recent modern times for bioimaging in numerous surgeries to aid in easier identification of occult and often tricky-to-find anatomical structures. Surgery becomes complex and challenging due to multiple anatomical anomalies, pathological fibrosis, obesity, or previous surgeries. To overcome these obstacles in surgery, the surgeon yearns to know the structures present beyond their white light vision so that while dissecting the organ, they can avoid injuring the critical systems in the vicinity of dissection. Near-infrared (NIR) imaging aids in visualising the tissues at depth/in the area of dissection, thereby preventing any possible surgical catastrophes due to them inadvertently damaging surrounding vital structures. Various advantages in surgeries like gastric sleeve surgery, lymph node and tumour detection, localisation of ureters and biliary tracts, and intraoperative tissue perfusion of flaps have been described in this study. This review article aims to compile a short list of utilities of ICG with NIR imaging in various surgical interventions. The merits and demerits of this imaging technique have been noted. The study points out the uses of ICG fluorescence imaging under different surgical fronts. This review article concludes by comparing the results of studies performed by various authors. Results have been compared to conventional surgical modalities.
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Affiliation(s)
- Nachiket P Rahate
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankita Kapse
- Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | | | - Sakshi P Nimbhorkar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Lim ZY, Mohan S, Balasubramaniam S, Ahmed S, Siew CCH, Shelat VG. Indocyanine green dye and its application in gastrointestinal surgery: The future is bright green. World J Gastrointest Surg 2023; 15:1841-1857. [PMID: 37901741 PMCID: PMC10600780 DOI: 10.4240/wjgs.v15.i9.1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023] Open
Abstract
Indocyanine green (ICG) is a water-soluble fluorescent dye that is minimally toxic and widely used in gastrointestinal surgery. ICG facilitates anatomical identification of structures (e.g., ureters), assessment of lymph nodes, biliary mapping, organ perfusion and anastomosis assessment, and aids in determining the adequacy of oncological margins. In addition, ICG can be conjugated to artificially created antibodies for tumour markers, such as carcinoembryonic antigen for colorectal, breast, lung, and gastric cancer, prostate-specific antigen for prostate cancer, and cancer antigen 125 for ovarian cancer. Although ICG has shown promising results, the optimization of patient factors, dye factors, equipment, and the method of assessing fluorescence intensity could further enhance its utility. This review summarizes the clinical application of ICG in gastrointestinal surgery and discusses the emergence of novel dyes such as ZW-800 and VM678 that have demonstrated appropriate pharmacokinetic properties and improved target-to-background ratios in animal studies. With the emergence of robotic technology and the increasing reporting of ICG utility, a comprehensive review of clinical application of ICG in gastrointestinal surgery is timely and this review serves that aim.
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Affiliation(s)
- Zavier Yongxuan Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Swetha Mohan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | | | - Saleem Ahmed
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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11
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Zhu C, Zeitouni F, Vaughan J, Santos AP. Laparoscopic management of combined cholecystogastric and cholecystocolonic fistulae. BMJ Case Rep 2023; 16:e255951. [PMID: 37558278 PMCID: PMC10414080 DOI: 10.1136/bcr-2023-255951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
Cholecystogastric and cholecystocolonic fistulae are rare sequelae of longstanding cholelithiasis and can complicate surgical management. Our case involves a male patient in his early 40s with a history of chronic cholelithiasis who presented to the emergency department with severe abdominal pain. Findings on imaging were consistent with acute calculous cholecystitis. During laparoscopic cholecystectomy, the presence of both cholecystogastric and cholecystocolonic fistulae was discovered. Fistula resection with cholecystectomy in a one-step approach using indocyanine green (ICG) angiography was performed. The patient improved and was discharged 3 days later. Laparoscopic management complemented by ICG angiography is a viable surgical approach in patients with cholecystogastric and cholecystocolonic fistulae.
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Affiliation(s)
- Christina Zhu
- Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Ferris Zeitouni
- Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Justin Vaughan
- Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
- Covenant Medical Center, Lubbock, Texas, USA
| | - Ariel P Santos
- Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
- Covenant Medical Center, Lubbock, Texas, USA
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Lie H, Irawan A, Sudirman T, Budiono BP, Prabowo E, Jeo WS, Rudiman R, Sitepu RK, Hanafi RV, Hariyanto TI. Efficacy and Safety of Near-Infrared Florescence Cholangiography Using Indocyanine Green in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2023; 33:434-446. [PMID: 36576572 DOI: 10.1089/lap.2022.0495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Achieving critical view of safety is a key for a successful laparoscopic cholecystectomy (LC) procedure. Near-infrared fluorescence cholangiography using indocyanine green (NIF-ICG) in LC has been extensively used and accepted as beneficial auxiliary tool to visualize extrahepatic biliary structures intraoperatively. This study aimed to analyze its safety and efficacy. Materials and Methods: Searching for potential articles up to March 25, 2022 were conducted on PubMed, Europe PMC, and ClinicalTrials.gov databases. Articles on the near infrared fluorescence during laparoscopy cholecystectomy were collected. Review Manager 5.4 software was utilized to perform the statistical analysis. Results: Twenty-two studies with a total of 3457 patients undergo LC for the analysis. Our meta-analysis revealed that NIF-ICG technique during LC was associated with shorter operative time (Std. Mean Difference -0.86 [95% confidence interval (CI) -1.49 to -0.23], P = .007, I2 = 97%), lower conversion rate (risk ratio [RR] 0.28 [95% CI 0.16-0.50], P < .0001, I2 = 0%), higher success in identification of cystic duct (CD) (RR 1.24 [95% CI 1.07-1.43], P = .003, I2 = 94%), higher success in identification of common bile duct (CBD) (RR 1.31 [95% CI 1.07-1.60], P = .009, I2 = 90%), and shorter time to identify biliary structures (Std. Mean Difference -0.52 [95% CI -0.78 to -0.26], P < .0001, I2 = 0%) compared with not using NIF-ICG. Conclusions: NIF-ICG technique beneficial for early real-time visualization of biliary structure, shorter operative time, and lower risk of conversion during LC. Larger randomized clinical trials are still needed to confirm the results of our study.
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Affiliation(s)
- Hendry Lie
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Andry Irawan
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Taufik Sudirman
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Bernardus Parish Budiono
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Diponegoro University, Dr. Kariadi General Hospital, Semarang, Indonesia
| | - Erik Prabowo
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Diponegoro University, Dr. Kariadi General Hospital, Semarang, Indonesia
| | - Wifanto Saditya Jeo
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ryanto Karobuana Sitepu
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Ricarhdo Valentino Hanafi
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Timotius Ivan Hariyanto
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
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13
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Hedaya MS, Ayad AMAE, Helmy AS, Sultan E. Indocyanine green direct injection into gallbladder during laparoscopic cholecystectomy: a safety method to outline biliary anatomy. THE EGYPTIAN JOURNAL OF SURGERY 2023; 42:549-553. [DOI: 10.4103/ejs.ejs_94_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background
One of the most frequently done operations in digestive surgery is the laparoscopic cholecystectomy (LC). Despite several safety precautions and guidelines, iatrogenic bile duct damage (BDI) during LC still occurs at a very high incidence. Fluorescence of biliary system may minimise surgical difficulties that might emerge owing to unintended harm to the common bile duct.
Methods
We outline a technique for directly injecting Indocyanine Green (ICG) into the gallbladder to clarify the architecture of the cystic duct and common bile duct. Fifty patients who underwent elective laparoscopic cholecystectomy participated in the study, which was a randomised controlled clinical trial. Patients who had intraoperative direct injection of ICG into the gallbladder were chosen at random using closed envelope technique, then using near-infrared fluorescence (NIF) imaging during LC) and controls (who underwent standard LC technique) Twenty five patients in each limb. Patients were studied pre-operative, intraoperative & postoperative. 50 patients in all, 25 of whom received LC with intracholecystic ICG injection, and 25 of whom underwent standard LC without the use of ICG, were included in our study.
Results
ICG dye was successful to delineate extrahepatic biliary anatomy well in 20 cases out of 25, while without ICG, 9 cases out of 25 were without clear delineation of common bile duct intraoperative even if cystic duct was clear enough to avoid complications in both groups . Operative Time average in cases with ICG-assisted LC was 78±15.0 min which was less than the average of time consumed in LC without ICG to dissect cystic duct and visualize critical view of safety, 101±11.87 min
Conclusion
Direct gallbladder ICG infusion enables quick extrahepatic biliary system imaging and clarifies the dissection, increasing protection against BDI and reducing intraoperative dissection time.
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Affiliation(s)
| | | | - Ayman Salah Helmy
- Department of General Surgery, Faculty of Medicine, Cairo University, Egypt
| | - Engy Sultan
- Department of General Surgery, Theodor Bilharz Research Institute TBRI, Egypt
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14
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Har B, Upadhyay Y, Bhojwani R. A 'twist' in the tale of a 'simple' laparoscopic cholecystectomy: Duplication of the gall bladder. J Minim Access Surg 2023; 19:320-322. [PMID: 37056093 PMCID: PMC10246645 DOI: 10.4103/jmas.jmas_206_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/13/2022] [Indexed: 03/19/2023] Open
Abstract
The duplication of the gall bladder (GB) is unusual biliary anatomy that can be encountered during cholecystectomy and can create intraoperative confusion if missed on pre-operative imaging. Here, we describe a case of duplication of GB in a young female, which was detected during laparoscopic cholecystectomy as an operative surprise. Laparoscopic cholecystectomy was done successfully with the removal of both the GBs. She was discharged uneventfully and remained symptom-free at a 6-month follow-up.
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Affiliation(s)
- Bappaditya Har
- Department of Surgical Gastroenterology, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India
| | - Yogesh Upadhyay
- Department of General Surgery, Rajiv Gandhi General Hospital, Alwar, Rajasthan, India
| | - Rajesh Bhojwani
- Department of Surgical Gastroenterology, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India
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15
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Cassinotti E, Al-Taher M, Antoniou SA, Arezzo A, Baldari L, Boni L, Bonino MA, Bouvy ND, Brodie R, Carus T, Chand M, Diana M, Eussen MMM, Francis N, Guida A, Gontero P, Haney CM, Jansen M, Mintz Y, Morales-Conde S, Muller-Stich BP, Nakajima K, Nickel F, Oderda M, Parise P, Rosati R, Schijven MP, Silecchia G, Soares AS, Urakawa S, Vettoretto N. European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery. Surg Endosc 2023; 37:1629-1648. [PMID: 36781468 PMCID: PMC10017637 DOI: 10.1007/s00464-023-09928-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/28/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND In recent years, the use of Indocyanine Green (ICG) fluorescence-guided surgery during open and laparoscopic procedures has exponentially expanded across various clinical settings. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on this topic with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS An expert panel of surgeons has been selected and invited to participate to this project. Systematic reviews of the PubMed, Embase and Cochrane libraries were performed to identify evidence on potential benefits of ICG fluorescence-guided surgery on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by the panel; they were then submitted to all EAES members through a two-rounds online survey and results presented at the EAES annual congress, Barcelona, November 2021. RESULTS A total of 18,273 abstracts were screened with 117 articles included. 22 statements and 16 recommendations were generated and approved. In some areas, such as the use of ICG fluorescence-guided surgery during laparoscopic cholecystectomy, the perfusion assessment in colorectal surgery and the search for the sentinel lymph nodes in gynaecological malignancies, the large number of evidences in literature has allowed us to strongly recommend the use of ICG for a better anatomical definition and a reduction in post-operative complications. CONCLUSIONS Overall, from the systematic literature review performed by the experts panel and the survey extended to all EAES members, ICG fluorescence-guided surgery could be considered a safe and effective technology. Future robust clinical research is required to specifically validate multiple organ-specific applications and the potential benefits of this technique on clinical outcomes.
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Affiliation(s)
- E Cassinotti
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy.
| | - M Al-Taher
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - S A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - L Baldari
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - L Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - M A Bonino
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Brodie
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - T Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - M Chand
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - M Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - M M M Eussen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - A Guida
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - P Gontero
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - C M Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Y Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - B P Muller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Oderda
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - P Parise
- U.O.C. Chirurgia Generale, Policlinico di Abano Terme, Abano Terme, PD, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - M P Schijven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, North Holland, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
| | - G Silecchia
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A S Soares
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - S Urakawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - N Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Montichiari, Italy
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16
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Preliminary results of laparoscopic cholecystectomy using real-time indocyanine green fluorescence: a cross-sectional study. Ann Med Surg (Lond) 2023; 85:402-406. [PMID: 36923758 PMCID: PMC10010799 DOI: 10.1097/ms9.0000000000000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/22/2023] [Indexed: 03/06/2023] Open
Abstract
Evaluating the results of laparoscopic cholecystectomy (LC) using indocyanine green (ICG) fluorescence. Materials and methods This is a cross-sectional study of patients with LC using real-time fluorescent ICG to treat gallbladder disease from May 2021 to May 2022 in the 108 Military Central Hospital. Results There were 68 patients who underwent LC using intraoperative ICG fluorescence for bile duct visualization. The mean age of the patients was 55.4±16.2, and the male/female ratio was 1.52. Chronic cholecystitis caused by stones accounted for the majority (51.47%). The authors detected 7.35% of cases with anatomical changes of the extrahepatic biliary tract using ICG fluorescence and clearly identified the anatomy of the common bile duct and the cystic duct at 100 and 92.65%, respectively. The average surgical time was 42.8±14.6 min. There were no postoperative complications or side effects from ICG; the average hospital stay was 2.8±1.5 days. Conclusions ICG fluorescence cholangiography allows surgeons to easily identify critical anatomical landmarks in the LC. Thereby helping the surgery to be performed safely, avoiding severe complications due to damage to the biliary tract.
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17
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Badawy A, El-Sayes IA, Sabra T. Image-guided laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography: what is the optimal time of administration? MINIM INVASIV THER 2022; 31:872-878. [DOI: 10.1080/13645706.2022.2026974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amr Badawy
- General Surgery Department, Faculty of Medicine, Alexandria University, Egypt
| | - Islam A. El-Sayes
- General Surgery Department, Faculty of Medicine, Alexandria University, Egypt
| | - Tarek Sabra
- General Surgery Department, Faculty of Medicine, Assuit University, Egypt
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18
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The Critical View of Safety in Laparoscopic Cholecystectomy: User Trends Among Residents and Consultants. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:453-461. [PMID: 35881992 DOI: 10.1097/sle.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Critical View of Safety (CVS) aims at preventing bile duct injuries (BDIs) in laparoscopic cholecystectomy (LCC). This study investigated CVS utilization among surgeons. METHODS Photos from LCCs were scored for satisfactory CVS. Rates of satisfactory CVS, BDIs, and postoperative complications among residents and consultants were compared. A lecture on CVS was given halfway through the study. RESULTS The study comprised 1532 patients. Residents had higher rates of satisfactory CVS in elective LCCs compared with consultants (34.9% vs. 23.0%, P<0.001), but not in emergency LCCs (18.4% vs. 15.0%, P=0.252). No significant differences in BDIs or postoperative complications emerged between residents and consultants. After the lecture, elective LCCs were photographed more frequently (80.3% vs. 74.0%, P=0.032), but rates of satisfactory CVS, BDIs, and postoperative complications remained unchanged. CONCLUSIONS Utilization of CVS can be affected by a single lecture but affecting rates of satisfactory CVS may require stronger interventions.
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Martinez-Onate ADJ, Martinez-Salas ADJ, Cazares-Garcia V. Fluorescence Guided Cholecystectomy by a Single Group: Initial 47 Procedures Experience in Mexico. JSLS 2022; 26:JSLS.2022.00043. [PMID: 36071995 DOI: 10.4293/jsls.2022.00043] [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: 11/22/2022] Open
Abstract
Introduction Fluorescence guided surgery (FGS) for biliary surgery uses indocyanine green (ICG), a specific dye that is eliminated almost exclusively by the liver and biliary system, making it very useful for an adequate and safe visualization of biliary tract structures. Methods We present our experience with FGS for cholecystectomy multiport and single port, including all patients older than 18 years of age, with diagnosis of cholecystitis (acute and chronic), from October 18, 2018 to December 30, 2021. Results A total of 47 patients were managed with FGS cholecystectomy, mean age was 61.2 (± 17.7) years, 31 (65.9%) were female and 16 (34.1%) males. Twenty-four (51.1%) were emergency procedures, due to acute cholecystitis, of which 10 (41.7%) presented with an infected gallbladder (Parkland 3 to 5) and three (12.5%) presented with related acute pancreatitis, the remaining 23 (48.9%) cases were elective surgeries, due to chronic cholecystitis. Visualization of laparoscopic fluorescence of the biliary ducts was achieved in 45 of the 47 patients (95.7%). Mean time for biliary tract structures visual identification was 8 minutes and 40 seconds (± 7 minutes, 20 seconds), fluorescence allowed the visualization of biliary tract anatomical variants in two patients. Discussion The reported rate of biliary structures visualization using ICG is relatively variable, ranging from 25% to 100%, in our group it was 95.7% due to our protocol. Conclusions ICG utilization for cholecystectomy is very useful and helps for a safe procedure even in difficult surgeries, we believe that it should be used in everyday practice.
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Affiliation(s)
| | | | - Vania Cazares-Garcia
- Department of Surgery, Hospital Santa Coleta, Hospital Angeles del Pedregal, Mexico City, Mexico
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20
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Castagneto-Gissey L, Russo MF, Iodice A, Casella-Mariolo J, Serao A, Picchetto A, D’Ambrosio G, Urciuoli I, De Luca A, Salvati B, Casella G. Intracholecystic versus Intravenous Indocyanine Green (ICG) Injection for Biliary Anatomy Evaluation by Fluorescent Cholangiography during Laparoscopic Cholecystectomy: A Case-Control Study. J Clin Med 2022; 11:jcm11123508. [PMID: 35743577 PMCID: PMC9224771 DOI: 10.3390/jcm11123508] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Fluorescence cholangiography has been proposed as a method for improving the visualization and identification of extrahepatic biliary anatomy in order to possibly reduce injuries and related complications. The most common method of indocyanine green (ICG) administration is the intravenous route, whereas evidence on direct ICG injection into the gallbladder is still quite limited. We aimed to compare the two different methods of ICG administration in terms of the visualization of extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC), analyzing differences in the time of visualization, as well as the efficacy, advantages, and disadvantages of both modalities. (2) Methods: A total of 35 consecutive adult patients affected by acute or chronic gallbladder disease were enrolled in this prospective case−control study. Seventeen patients underwent LC with direct gallbladder ICG injection (IC-ICG) and eighteen subjects received intravenous ICG administration (IV-ICG). (3) Results: The groups were comparable with regard to their demographic and perioperative characteristics. The IV-ICG group had a significantly shorter overall operative time compared to the IC-ICG group (p = 0.017). IV-ICG was better at delineating the duodenum and the common hepatic duct compared to the IC-ICG method (p = 0.009 and p = 0.041, respectively). The cystic duct could be delineated pre-dissection in 76.5% and 66.7% of cases in the IC-ICG and IV-ICG group, respectively, and this increased to 88.2% and 83.3% after dissection. The common bile duct could be highlighted in 76.5% and 77.8% of cases in the IC-ICG and IV-ICG group, respectively. Liver fluorescence was present in one case in the IC-ICG group and in all cases after IV-ICG administration (5.8% versus 100%; p < 0.0001). (4) Conclusions: The present study demonstrates how ICG-fluorescence cholangiography can be helpful in identifying the extrahepatic biliary anatomy during dissection of Calot’s triangle in both administration methods. In comparison with intravenous ICG injection, the intracholecystic ICG route could provide a better signal-to-background ratio by avoiding hepatic fluorescence, thus increasing the bile duct-to-liver contrast.
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Affiliation(s)
- Lidia Castagneto-Gissey
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - Maria Francesca Russo
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - Alessandra Iodice
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - James Casella-Mariolo
- Department of General and Emergency Surgery, Ospedale dei Castelli (NOC), ASL Roma 6, 00040 Rome, Italy; (J.C.-M.); (A.S.)
| | - Angelo Serao
- Department of General and Emergency Surgery, Ospedale dei Castelli (NOC), ASL Roma 6, 00040 Rome, Italy; (J.C.-M.); (A.S.)
| | - Andrea Picchetto
- Department of General Surgery, Surgical Specialties and Organ Transplantation, Sapienza University of Rome, 00161 Rome, Italy; (A.P.); (G.D.)
| | - Giancarlo D’Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation, Sapienza University of Rome, 00161 Rome, Italy; (A.P.); (G.D.)
| | - Irene Urciuoli
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - Alessandro De Luca
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - Bruno Salvati
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
| | - Giovanni Casella
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.C.-G.); (M.F.R.); (A.I.); (I.U.); (A.D.L.); (B.S.)
- Correspondence: ; Tel.: +39-064-997-5515
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21
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Tseng C, Huang PW, Huang SW, Chen YC, Hung MC, Wong HP, Chou DA. Study of Learning Curve in a Surgeon for Near-Infrared Fluorescence Cholangiography During Laparoscopic Cholecystectomy-A Retrospective Evaluation. Surg Innov 2022; 29:519-525. [PMID: 35482941 DOI: 10.1177/15533506221093239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Near-infrared indocyanine green fluorescence cholangiography (NIRF) has shown promising results on delineating extra-hepatic biliary anatomy during laparoscopic cholecystectomy to avoid bile duct injury. However its routine usage remains in question. In this study, the technique was evaluated further with learning curve estimation and learning factors were observed. METHODS One hundred ninety-nine cases which underwent laparoscopic cholecystectomy for acute or chronic cholecystitis within a 2-year period including 51 cases with initial use of NIRF by 2 surgeons were studied retrospectively. The learning curve was evaluated for a surgeon as primary objective. A case-matched comparison of the operative time between NIRF and conventional group, in terms of acute and chronic cholecystitis was also conducted as a secondary calculation. RESULTS Learning curve was evaluated with 61% learning rate for NIRF experience. Cysto-biliary junction non-illuminated cases under fluorescent view, had mean operative time of 80.83 ± 22.82 min, which was shorter than the cysto-biliary junction illuminated cases. The NIRF group exhibited longer operative time compared with the conventional group with mean difference of 34.39 min (significant at P < .05). CONCLUSIONS While the initial learning phase might be affected by surgeons' behavior and attitude, our results may provide a reference to learn at one's own pace and to employ NIRF teaching strategies during surgical training programs to overcome the initial phase during training period itself and facilitate universal achievement.
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Affiliation(s)
- Chun Tseng
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ping-Wen Huang
- Department of Emergency Medicine, 63295Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Shih-Wei Huang
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan.,IRCAD/AITS-Asian Institute of TeleSurgery, Show Chwan Health Care System, Changhua, Taiwan
| | - Yi-Chun Chen
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Min-Chang Hung
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Hon Phin Wong
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan.,IRCAD/AITS-Asian Institute of TeleSurgery, Show Chwan Health Care System, Changhua, Taiwan
| | - Dev-Aur Chou
- Department of Surgery, 63295Show Chwan Memorial Hospital, Changhua, Taiwan
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Serban D, Badiu D, Davitoiu D, Tanasescu C, Tudosie M, Sabau A, Dascalu A, Tudor C, Balasescu S, Socea B, Costea D, Zgura A, Costea A, Tribus L, Smarandache C. Systematic review of the role of indocyanine green near‑infrared fluorescence in safe laparoscopic cholecystectomy (Review). Exp Ther Med 2021; 23:187. [DOI: 10.3892/etm.2021.11110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dragos Serban
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dumitru Badiu
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dragos Davitoiu
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ciprian Tanasescu
- Third Clinical Department, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Mihail Tudosie
- Discipline of Clinical Toxicology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alexandru Sabau
- Third Clinical Department, Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Ana Dascalu
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Corneliu Tudor
- Fourth Department of Surgery, Emergency University Hospital, 050098 Bucharest, Romania
| | - Simona Balasescu
- Fourth Department of Surgery, Emergency University Hospital, 050098 Bucharest, Romania
| | - Bogdan Socea
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniel Costea
- Department of Clinical Surgical Disciplines I, Faculty of Medicine, Ovidius University, 900527 Constanta, Romania
| | - Anca Zgura
- Department of Radiology, Oncology, and Hematology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020011 Bucharest, Romania
| | - Andreea Costea
- Department of Nephrology and Dialysis, ‘Diaverum’ Clinic, 900612 Constanta, Romania
| | - Laura Tribus
- Department of Internal Medicine Gastroenterology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020011 Bucharest, Romania
| | - Catalin Smarandache
- Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
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23
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Lu CH, Hsiao JK. Indocyanine green: An old drug with novel applications. Tzu Chi Med J 2021; 33:317-322. [PMID: 34760625 PMCID: PMC8532591 DOI: 10.4103/tcmj.tcmj_216_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/05/2020] [Accepted: 10/31/2020] [Indexed: 12/18/2022] Open
Abstract
Indocyanine green (ICG), a US Food and Drug Administration-approved fluorescent compound, has been on the medical stage for more than 60 years. Current uses include hepatic function evaluation before surgical procedure and fundus evaluation. The large safety margin and near-infrared fluorescent optical advantage of the drug have proved useful in several clinical trials of intraoperative systems for tumor removal. Several nanoparticle-sized formulations for thermal ablation and photodynamic therapy have also been evaluated in animal experiments. Studies have attempted to manipulate ICG as a reporter fluorophore with initial success. In this article, we reviewed ICG's histological applications, chemical and physical properties, current clinical applications, ongoing clinical trials, and biomedical studies and prospects. We believe that ICG could be used with novel biotechnological techniques, such as fluorescent endoscopy and photoacoustic equipment, in a range of biomedical fields.
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Affiliation(s)
- Chia-Hung Lu
- Department of Medical Imaging, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Jong-Kai Hsiao
- Department of Medical Imaging, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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24
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Franz M, Arend J, Wolff S, Perrakis A, Rahimli M, Negrini VR, Stockheim J, Lorenz E, Croner R. Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery - valuation of early adopters from Germany. Innov Surg Sci 2021; 6:59-66. [PMID: 34589573 PMCID: PMC8435269 DOI: 10.1515/iss-2020-0019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/11/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives Indocyanine green (ICG) is a fluorescent dye which was initially used for liver functional assessment. Moreover, it is of value for intraoperative visualization of liver segments and bile ducts or primary and secondary liver tumors. Especially in minimally invasive liver surgery, this is essential to enhance the precision of anatomical guided surgery and oncological quality. As early adopters of ICG implementation into laparoscopic and robotic-assisted liver surgery in Germany, we summarize the current recommendations and share our experiences. Methods Actual strategies for ICG application in minimally invasive liver surgery were evaluated and summarized during a review of the literature. Experiences in patients who underwent laparoscopic or robotic-assisted liver surgery with intraoperative ICG staining between 2018 and 2020 from the Magdeburg registry for minimally invasive liver surgery (MD-MILS) were evaluated and the data were analyzed retrospectively. Results ICG can be used to identify anatomical liver segments by fluorescence angiography via direct or indirect tissue staining. Fluorescence cholangiography visualizes the intra- and extrahepatic bile ducts. Primary and secondary liver tumors can be identified with a sensitivity of 69-100%. For this 0.5 mg/kg body weight ICG must be applicated intravenously 2-14 days prior to surgery. Within the MD-MILS we identified 18 patients which received ICG for intraoperative tumor staining of hepatocellular carcinoma (HCC), cholangiocarcinoma, peritoneal HCC metastases, adenoma, or colorectal liver metastases. The sensitivity for tumor staining was 100%. In 27.8% additional liver tumors were identified by ICG fluorescence. In 39% a false positive signal could be detected. This occurred mainly in cirrhotic livers. Conclusions ICG staining is a simple and useful tool to assess individual hepatic anatomy or to detect tumors during minimally invasive liver surgery. It may enhance surgical precision and improve oncological quality. False-positive detection rates of liver tumors can be reduced by respecting the tumor entity and liver functional impairments.
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Affiliation(s)
- Mareike Franz
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Jörg Arend
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Stefanie Wolff
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Aristotelis Perrakis
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Mirhasan Rahimli
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Victor-Radu Negrini
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Jessica Stockheim
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Eric Lorenz
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Roland Croner
- Department of General-, Visceral-, Vascular-, and Transplant-Surgery, University Hospital Magdeburg, Magdeburg, Germany
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25
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Kim J, Hong SK, Lim J, Lee JM, Cho JH, Choi Y, Yi NJ, Lee KW, Suh KS. Demarcating the Exact Midplane of the Liver Using Indocyanine Green Near-Infrared Fluorescence Imaging During Laparoscopic Donor Hepatectomy. Liver Transpl 2021; 27:830-839. [PMID: 33583130 DOI: 10.1002/lt.26019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/10/2021] [Accepted: 02/07/2021] [Indexed: 01/13/2023]
Abstract
Indocyanine green (ICG) near-infrared fluoroscopy has been recently implemented in pure laparoscopic donor hepatectomy (PLDH). This study aims to quantitatively evaluate the effectiveness of ICG fluoroscopy during liver midplane dissection in PLDH and to demonstrate that a single injection of ICG is adequate for both midplane dissection and bile duct division. Retrospective analysis was done with images acquired from recordings of PLDH performed without ICG (pre-ICG group) from November 2015 to May 2016 and with ICG (post-ICG group) from June 2016 to May 2017. 30 donors from the pre-ICG group were compared with 46 donors from the post-ICG group. The operation time was shorter (P = 0.002) and postoperative peak aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were lower (P = 0.031 and P = 0.019, respectively) in the post-ICG group than the pre-ICG group. Within the post-ICG group, the color intensity differences between the clamped versus nonclamped regions in the natural, black-and-white, and fluorescent modes were 39.7 ± 36.2, 89.6 ± 46.9, and 19.1 ± 36.8 (mean ± SD, P < 0.001), respectively. The luminosity differences were 37.2 ± 34.5, 93.8 ± 32.1, and 26.7 ± 25.7 (P < 0.001), respectively. Meanwhile, the time from when ICG was injected to when the near-infrared camera was turned on for bile duct visualization was 85.6 ± 25.8 minutes. All grafts received from the 46 donors were successfully transplanted. In conclusion, ICG fluoroscopy helps to reduce operation time and lower postoperative AST/ALT levels. ICG injection visualized with black-and-white imaging is most effective for demarcating the liver midplane during PLDH. A single intravenous injection of ICG is sufficient for midplane dissection as well as bile duct division.
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Affiliation(s)
- Jeesun Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jieun Lim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyung Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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26
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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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27
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Gandhi JA, Shinde PH, Chaudhari SN, Banker AM. Novel Use of Intraoperative Fluoroscopy in an Era of ICG for Complex Laparoscopic Cholecystectomy. Surg J (N Y) 2021; 7:e35-e40. [PMID: 33659641 PMCID: PMC7917001 DOI: 10.1055/s-0040-1721432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/14/2020] [Indexed: 12/07/2022] Open
Abstract
Background
Laparoscopic cholecystectomy (LC) is increasingly being used as a first-line treatment for acute cholecystitis. Bile duct injury (BDI) remains the most feared complication of the minimally invasive approach specially in cases with an inflamed calots triangle. While use of indocyanine dye (ICG) to delineate biliary anatomy serves to reduce BDI, the high cost of the technology prohibits its use in the developing world. We propose a novel use of common bile duct (CBD) stenting preoperatively in cases of cholecystitis secondary to choledocholithiasis as a means of identification and safeguarding the CBD.
Methods
A retrospective review was conducted on 22 patients of Grade 2 or Grade 3 cholecystitis who underwent an early LC at our institution. All patients were stented preoperatively and the stent was used for a much-needed tactile feedback during dissection. A c-arm with intraoperative fluoroscopy was used to identify the CBD prior to clipping of the cystic duct.
Results
The gall bladder was gangrenous in all the cases while two cases had evidence of end organ damage. This innovative use of CBD stenting allowed us to correctly delineate biliary anatomy in all of the cases and we report no instances of BDI despite a severely inflamed local environment.
Conclusion
This technique can become a standard of care in all teaching institutions in developing countries further enhancing the safety of cholecystectomy in gangrenous cholecystitis with a distorted biliary anatomy.
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Affiliation(s)
- Jignesh A Gandhi
- Department of GI and Laparoscopic Surgery, Global Hospital, Mumbai, Maharashtra, India
| | - Pravin H Shinde
- Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sadashiv N Chaudhari
- Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Amay M Banker
- Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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28
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Lwin TM, Hoffman RM, Bouvet M. Fluorescence-guided hepatobiliary surgery with long and short wavelength fluorophores. Hepatobiliary Surg Nutr 2020; 9:615-639. [PMID: 33163512 DOI: 10.21037/hbsn.2019.09.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Fluorescence-guided surgery (FGS) is a potentially powerful tool for hepatobiliary (HPB) surgery. The high sensitivity of fluorescence navigation is especially useful in settings where tactile feedback is limited. Objective The present narrative review evaluates literature on the use of FDA-approved fluorophores such as methylene blue (MB), 5-aminolevulinic acid (5-ALA), and indocyanine green (ICG) for clinical intra-operative image-guidance during HPB surgery. Evidence Review Approaches such as dosing, timing, imaging devices and comparative endpoints are summarized. The feasibility and safety of fluorophores in visualizing the biliary tree, identify biliary leaks, outline anatomic hepatic segments, identify tumors, and evaluate perfusion and graft function in liver transplants are discussed. Findings Tumor-specific probes are a promising advancement in FGS with a greater degree of specificity. The current status of tumor-specific probes being evaluated in clinical trials are summarized. Conclusions and Relevance for Reviews Relevant discussion of promising tumor-specific probes in pre-clinical development are discussed. Fluorescence-guidance in HPB surgery is relatively new, but current literature shows that the dyes are reliably able to outline desired structures with a variety of dosing, timing, and imaging devices to provide real-time intra-operative anatomic information to surgeons. Development of tumor-specific probes will further advance the field of HPB surgery especially during oncologic resections.
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Affiliation(s)
- Thinzar M Lwin
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Robert M Hoffman
- Department of Surgery, University of California San Diego, San Diego, CA, USA.,AntiCancer, Inc., San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - Michael Bouvet
- Department of Surgery, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
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29
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Di Maggio F, Hossain N, De Zanna A, Husain D, Bonomo L. Near-Infrared Fluorescence Cholangiography can be a Useful Adjunct during Emergency Cholecystectomies. Surg Innov 2020; 29:526-531. [PMID: 32936054 DOI: 10.1177/1553350620958562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background. Emergency cholecystectomy is the gold standard treatment for acute cholecystitis according to National Institute for Health and Care Excellence recommendations. The procedure is feasible but carries a higher risk of iatrogenic injury to the bile duct, which should be considered preventable. Intraoperative fluorescence cholangiography following injection of indocyanine green (ICG) has been reported to aid identification of the extrahepatic bile duct. Data on its feasibility in the context of emergency cholecystectomies are missing. Materials and Methods. Fluorescent ICG was used intraoperatively to enhance the biliary anatomy during 33 consecutive emergency laparoscopic cholecystectomies at our institution. Primary outcomes of surgery were considered the length of hospital stay, conversion to open and complications rate, including bile duct injury. Secondary outcome was operating time. A historical population of emergency cholecystectomies was used as control. Results. There were no common bile duct injuries, no adverse effects from ICG, no conversion to open surgery and no deaths. 90% of patients went home within 48 hours after the operation in the absence of complications. ICG demonstrated intraoperative biliary anatomy allowing greater confidence to the surgeon performing emergency cholecystectomies. Six patients were operated beyond 72 hours from admission, without experiencing any complication Clavien-Dindo ≥3. ICG population had the same post-operative hospitalisation and complications rate of the control group, with a shorter operating time. Conclusion. Intraoperative augmented visualisation of biliary anatomy with ICG cholangiography can be a useful technology tool, with the potential to extend the 72 hours window of safety for emergency cholecystectomies.
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Affiliation(s)
- Francesco Di Maggio
- Upper GI Unit, St Thomas Hospital, 8945Guys and St Thomas NHS Foundation Trust, UK
| | - Naveed Hossain
- Upper GI Unit, St Thomas Hospital, 8945Guys and St Thomas NHS Foundation Trust, UK.,Emergency General Surgery, St Thomas Hospital, 8945Guys and St Thomas NHS Foundation Trust, UK
| | - Andrea De Zanna
- Upper GI Unit, St Thomas Hospital, 8945Guys and St Thomas NHS Foundation Trust, UK.,Emergency General Surgery, St Thomas Hospital, 8945Guys and St Thomas NHS Foundation Trust, UK
| | - Danya Husain
- Upper GI Unit, St Thomas Hospital, 8945Guys and St Thomas NHS Foundation Trust, UK.,Emergency General Surgery, St Thomas Hospital, 8945Guys and St Thomas NHS Foundation Trust, UK
| | - Luca Bonomo
- Emergency General Surgery, St Thomas Hospital, 8945Guys and St Thomas NHS Foundation Trust, UK
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30
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Turcotte J, Leydorf SD, Ali M, Feather C, Klune JR. Indocyanine green does not decrease the need for bail-out operation in an acute care surgery population. Surgery 2020; 169:227-231. [PMID: 32718803 DOI: 10.1016/j.surg.2020.05.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/02/2020] [Accepted: 05/27/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The use of indocyanine green during laparoscopic cholecystectomy has been postulated to help to define anatomy. Studies have not specifically evaluated patients with acute cholecystitis. We sought to assess whether use of indocyanine green can decrease the rate of bail-out operation (subtotal cholecystectomy or conversion to an open operation) in an acute care surgery population where acute cholecystitis is more frequent. METHODS Using a retrospective cohort design, we examined all inpatient cholecystectomies performed by the acute care surgery service under urgent or semiurgent (biliary colic as the presentation in the emergency room) conditions at a single institution from 7/1/18 to 6/30/19 during which indocyanine green was available for use at the surgeon's discretion. RESULTS A total of 198 patients were included in the analysis. Demographic variables were similar in groups receiving indocyanine green versus not. Pathology confirmed acute cholecystitis was present in 96 of 198 (48.5%) patients; of those, 55 (57.2%) received indocyanine green. Indocyanine green did not change the rate of bail-out operation between patients who received indocyanine green and those who did not (6.7% vs 4.3%, P = .468). No significant differences in complications were observed. Bail-out operation was more likely in cases of acute cholecystitis (9.4%) versus nonacute cholecystitis (2.0%) (odds ratio = 5.172, P = .039). In patients with acute cholecystitis, indocyanine green did not change the rate of bail-out operation (indocyanine green: 12.7% vs no indocyanine green: 4.9%, P = .293). CONCLUSION This is the first series looking at the use of indocyanine green specifically in an acute care surgery population. Indocyanine green did not decrease operative time or need for a bail-out operation in acute cholecystitis. Further study is needed to determine whether indocyanine green use is justified in this population.
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Affiliation(s)
- Justin Turcotte
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD
| | - S Daniel Leydorf
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD
| | - Moneim Ali
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD
| | - Cristina Feather
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD
| | - J Robert Klune
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD.
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31
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Cheruiyot I, Nyaanga F, Kipkorir V, Munguti J, Ndung'u B, Henry B, Cirocchi R, Tomaszewski K. The prevalence of the Rouviere's sulcus: A meta-analysis with implications for laparoscopic cholecystectomy. Clin Anat 2020; 34:556-564. [PMID: 32285514 DOI: 10.1002/ca.23605] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022]
Abstract
Rouvière's sulcus (RS) is increasingly being recognized as an important extra-biliary landmark during laparoscopic cholecystectomy (LC). The aim of this study was to conduct a systematic analysis of the prevalence and morphological types of RS. A systematic search was conducted through the major databases PubMed, ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), SciELO, and the Cochrane Library to identify studies eligible for inclusion. The data were extracted and pooled into a random-effects meta-analysis using STATA software. The primary and secondary outcomes of the study were the pooled prevalence of RS and its morphological types, respectively. A total of 23 studies (n = 4,495 patients) were included. The overall pooled prevalence of RS was 83% (95% confidence interval [CI] [78, 87]). There were no significant differences in prevalence between cadaveric studies (82%, 95% CI [76, 87]) and laparoscopic studies (83%, 95% CI [77, 88]). The open RS constituted 66% (95% CI [61, 71]) of all cases, while the closed type was present in 34% (95% CI [29, 39]). RS is a relatively constant anatomical structure that can be reliably identified in most patients undergoing cholecystectomy. It can therefore be used as a fixed extra-biliary landmark for the appropriate site at which to start dissecting during LC to help prevent iatrogenic bile duct injury.
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Affiliation(s)
- Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,International Evidence-Based Anatomy Working Group, Jagiellonian University, Krakow, Poland
| | - Fiona Nyaanga
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Vincent Kipkorir
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Jeremiah Munguti
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Bernard Ndung'u
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Brandon Henry
- International Evidence-Based Anatomy Working Group, Jagiellonian University, Krakow, Poland.,Cincinnati Children's Medical Centre, Cincinnati, Ohio, USA
| | - Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Perugia, Italy
| | - Krzysztof Tomaszewski
- International Evidence-Based Anatomy Working Group, Jagiellonian University, Krakow, Poland
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32
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Widen JC, Tholen M, Yim JJ, Bogyo M. Methods for analysis of near-infrared (NIR) quenched-fluorescent contrast agents in mouse models of cancer. Methods Enzymol 2020; 639:141-166. [PMID: 32475399 DOI: 10.1016/bs.mie.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Optical contrast agents containing near-infrared (NIR) fluorophores are useful for visualizing biological landmarks, enzyme activities and biological processes in live animals and humans. Activatable (smart) quenched-fluorescent probes are sensors that become fluorescent after processing by an enzyme or in response to a physiological change (i.e., pH, ROS, etc.). Recently, there has been increased interest in developing activatable probes for research and clinical applications. This requires evaluation using in vivo animal models to gain insights into the pharmacodynamic and pharmacokinetic properties of a given probe. Important parameters to measure when evaluating quenched-fluorescent probes are signal brightness and signal-to-background ratios, which define the sensitivity and specificity of a probe. In this chapter, we discuss methods to evaluate activatable quenched-fluorescent probes in mouse models of cancer. Quantification of fluorescent signal intensity, calculation of tumor-to-background ratios, comparison of fluorescent activation in specific organ compartments, and fluorescence scanning of sectioned tissue will be discussed.
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Affiliation(s)
- John C Widen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Martina Tholen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Joshua J Yim
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States; Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew Bogyo
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States; Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, United States; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, United States.
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