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

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Abstract

Background

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.

Methods

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

Results

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).

Conclusion

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.

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Abbreviations

BDI:

Bile duct injury

BMI:

Body mass index

CI:

Confidence interval

CRP:

C-reactive protein

CTA:

CT angiography

DIC-CT:

Drip infusion cholecystocholangiography-CT

ICG:

Indocyanine green

LC:

Laparoscopic cholecystectomy

PTGBD:

Percutaneous transhepatic gallbladder drainage

WBC:

White blood cell

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Surgery, Iizuka Hospital, Iizuka, Fukuoka, 820-8505, Japan

    Shohei Yoshiya, Ryosuke Minagawa, Keisuke Kamo, Meidai Kasai, Kenji Taketani, Takafumi Yukaya, Yasue Kimura, Tadashi Koga, Masanori Kai & Kiyoshi Kajiyama

  2. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan

    Shohei Yoshiya & Tomoharu Yoshizumi

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  1. Shohei Yoshiya
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  2. Ryosuke Minagawa
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  6. Takafumi Yukaya
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  11. Tomoharu Yoshizumi
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Correspondence to Shohei Yoshiya.

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Yoshiya, S., Minagawa, R., Kamo, K. et al. Usability of Intraoperative Fluorescence Imaging with Indocyanine Green During Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage. World J Surg 43, 127–133 (2019). https://doi.org/10.1007/s00268-018-4760-1

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  • DOI: https://doi.org/10.1007/s00268-018-4760-1

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