World Journal of Surgery

, Volume 43, Issue 1, pp 127–133 | Cite as

Usability of Intraoperative Fluorescence Imaging with Indocyanine Green During Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage

  • Shohei YoshiyaEmail author
  • Ryosuke Minagawa
  • Keisuke Kamo
  • Meidai Kasai
  • Kenji Taketani
  • Takafumi Yukaya
  • Yasue Kimura
  • Tadashi Koga
  • Masanori Kai
  • Kiyoshi Kajiyama
  • Tomoharu Yoshizumi
Original Scientific Report



Patients with persistent symptoms of acute cholecystitis for >72 h who cannot undergo urgent laparoscopic cholecystectomy (LC) often undergo percutaneous transhepatic gallbladder drainage (PTGBD) and delayed LC. However, intraoperative near-infrared fluorescence with indocyanine green (ICG) has recently become available in various surgical settings. Therefore, we evaluated the usability of intraoperative fluorescence imaging with ICG for LC after PTGBD in patients with acute cholecystitis.


The preoperative and postoperative clinical characteristics of patients who underwent LC after PTGBD were retrospectively analyzed.


In total, 130 patients were reviewed. Intraoperative ICG fluorescence imaging was used in 39 (30.0%) patients, and none developed adverse reactions. Patients with ICG fluorescence imaging had a significantly shorter operative time (129 ± 46 vs. 150 ± 56 min, p = 0.0455), markedly lower conversion rate (2.6% vs. 22.0%, p = 0.0017), and lower proportion of subtotal cholecystectomy (0.0% vs. 6.6%, p = 0.0359) than patients without ICG fluorescence imaging. Independent risk factors for conversion to laparotomy during LC after PTGBD were the performance of PTGBD after 48 h from onset (OR 3.52; 95% CI 1.11–12.21; p = 0.0322), an unremoved PTGBD tube on LC (4.48, 1.46–15.00, p = 0.0084), and surgery without ICG (8.00, 1.28–159.47, p = 0.0231).


Intraoperative ICG fluorescence imaging produced better surgical outcomes without any adverse reactions. Early performance of PTGBD and intraoperative ICG fluorescence imaging can reduce the surgical difficulties in LC after PTGBD for acute cholecystitis.



Bile duct injury


Body mass index


Confidence interval


C-reactive protein


CT angiography


Drip infusion cholecystocholangiography-CT


Indocyanine green


Laparoscopic cholecystectomy


Percutaneous transhepatic gallbladder drainage


White blood cell



This study was supported in part by a Grant-in-Aid for Scientific Research (KAKENHI) from the Ministry of Health, Labour and Welfare of Japan (16K19935). The funding source had no role in the collection, analysis, or interpretation of the data, or in the decision to submit the article for publication. The authors declare no conflicts of interest.


  1. 1.
    Flum DR, Dellinger EP, Cheadle A et al (2003) Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA J Am Med Assoc 289:1639–1644CrossRefGoogle Scholar
  2. 2.
    Nuzzo G, Giuliante F, Giovannini I et al (2005) Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch Surg 140:986–992CrossRefGoogle Scholar
  3. 3.
    Waage A, Nilsson M (2006) Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish Inpatient Registry. Arch Surg 141:1207–1213CrossRefGoogle Scholar
  4. 4.
    Liu YY, Kong SH, Diana M et al (2016) Near-infrared cholecysto-cholangiography with indocyanine green may secure cholecystectomy in difficult clinical situations: proof of the concept in a porcine model. Surg Endosc 30:4115–4123CrossRefGoogle Scholar
  5. 5.
    Navez B, Ungureanu F, Michiels M et al (2012) Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium. Surg Endosc 26:2436–2445CrossRefGoogle Scholar
  6. 6.
    Yamada K, Yamashita Y, Yamada T et al (2015) Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis. J Hepato-Biliary-Pancreat Sci 22:855–861CrossRefGoogle Scholar
  7. 7.
    Komatsu S, Tsukamoto T, Iwasaki T et al (2014) Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis. J Dig Dis 15:669–675CrossRefGoogle Scholar
  8. 8.
    Itoi T, Takada T, Hwang TL et al (2017) Percutaneous and endoscopic gallbladder drainage for acute cholecystitis: international multicenter comparative study using propensity score-matched analysis. J Hepato-Biliary-Pancreat Sci 24:362–368CrossRefGoogle Scholar
  9. 9.
    Miura F, Takada T, Strasberg SM et al (2013) TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepato-Biliary-Pancreat Sci 20:47–54CrossRefGoogle Scholar
  10. 10.
    Iwashita Y, Ohyama T, Honda G et al (2016) What are the appropriate indicators of surgical difficulty during laparoscopic cholecystectomy? Results from a Japan-Korea-Taiwan multinational survey. J Hepato-Biliary-Pancreat Sci 23:533–547CrossRefGoogle Scholar
  11. 11.
    Sugie T, Ikeda T, Kawaguchi A et al (2017) Sentinel lymph node biopsy using indocyanine green fluorescence in early-stage breast cancer: a meta-analysis. Int J Clin Oncol 22:11–17CrossRefGoogle Scholar
  12. 12.
    Yukaya T, Saeki H, Kasagi Y et al (2015) Indocyanine green fluorescence angiography for quantitative evaluation of gastric tube perfusion in patients undergoing esophagectomy. J Am Coll Surg 221:e37–e42CrossRefGoogle Scholar
  13. 13.
    Kawaguchi Y, Nomura Y, Nagai M et al (2017) Liver transection using indocyanine green fluorescence imaging and hepatic vein clamping. Br J Surg 104:898–906CrossRefGoogle Scholar
  14. 14.
    Mitsuhashi N, Kimura F, Shimizu H et al (2008) Usefulness of intraoperative fluorescence imaging to evaluate local anatomy in hepatobiliary surgery. J Hepato-Biliary-Pancreat Surg 15:508–514CrossRefGoogle Scholar
  15. 15.
    Ishizawa T, Tamura S, Masuda K et al (2009) Intraoperative fluorescent cholangiography using indocyanine green: a biliary road map for safe surgery. J Am Coll Surg 208:e1–e4CrossRefGoogle Scholar
  16. 16.
    Ishizawa T, Bandai Y, Kokudo N (2009) Fluorescent cholangiography using indocyanine green for laparoscopic cholecystectomy: an initial experience. Arch Surg 144:381–382CrossRefGoogle Scholar
  17. 17.
    Mordon S, Devoisselle JM, Soulie-Begu S et al (1998) Indocyanine green: physicochemical factors affecting its fluorescence in vivo. Microvasc Res 55:146–152CrossRefGoogle Scholar
  18. 18.
    Osayi SN, Wendling MR, Drosdeck JM et al (2015) Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy. Surg Endosc 29:368–375CrossRefGoogle Scholar
  19. 19.
    Ishizawa T, Bandai Y, Ijichi M et al (2010) Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy. Br J Surg 97:1369–1377CrossRefGoogle Scholar
  20. 20.
    Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125Google Scholar
  21. 21.
    Takada T, Strasberg SM, Solomkin JS et al (2013) TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepato-Biliary-Pancreat Sci 20:1–7CrossRefGoogle Scholar
  22. 22.
    de Mestral C, Gomez D, Haas B et al (2013) Cholecystostomy: a bridge to hospital discharge but not delayed cholecystectomy. J Trauma Acute Care Surg 74:175–179 discussion 179-180 CrossRefGoogle Scholar
  23. 23.
    Paran H, Zissin R, Rosenberg E et al (2006) Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Int J Surg 4:101–105CrossRefGoogle Scholar
  24. 24.
    El-Gendi A, El-Shafei M, Emara D (2017) Emergency versus delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in grade II acute cholecystitis patients. J Gastrointest Surg 21:284–293CrossRefGoogle Scholar
  25. 25.
    Shibasaki S, Takahashi N, Toi H et al (2014) Percutaneous transhepatic gallbladder drainage followed by elective laparoscopic cholecystectomy in patients with moderate acute cholecystitis under antithrombotic therapy. J Hepato-Biliary-Pancreat Sci 21:335–342CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Shohei Yoshiya
    • 1
    • 2
    Email author
  • Ryosuke Minagawa
    • 1
  • Keisuke Kamo
    • 1
  • Meidai Kasai
    • 1
  • Kenji Taketani
    • 1
  • Takafumi Yukaya
    • 1
  • Yasue Kimura
    • 1
  • Tadashi Koga
    • 1
  • Masanori Kai
    • 1
  • Kiyoshi Kajiyama
    • 1
  • Tomoharu Yoshizumi
    • 2
  1. 1.Department of SurgeryIizuka HospitalIizuka, FukuokaJapan
  2. 2.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan

Personalised recommendations