Near-infrared cholecystocholangiography with direct intragallbladder indocyanine green injection: preliminary clinical results
Near-infrared (NIR) fluorescence cholangiography by systemic administration of indocyanine green (ICG) enhances the visualization of the biliary tree anatomy. However, the simultaneous enhancement of liver parenchyma can disturb the visualization of critical details. We herein proposed a new technique of NIR cholecystocholangiography by intragallbladder ICG injection to increase the safety during laparoscopic cholecystectomy.
A total of 46 patients scheduled for laparoscopic cholecystectomy for symptomatic lithiasis (n = 21) or cholecystitis (n = 25) were enrolled. A fluorescence cholangiography by direct gallbladder injection of ICG was performed in all cases. Of them, the ICG was injected through a previously placed percutaneous transhepatic gallbladder drainage catheter (n = 18) or by intraoperative, percutaneous needle puncture of the gallbladder (n = 28). Visualization of biliary structures, including the cystic duct (CD), the common bile and hepatic ducts (CBD and CHD), the gallbladder neck, and the Hartmann’s pouch (HP), was performed using White Light (served as control modality) and by NIR enhancement.
Cholecystocholangiography provided a significantly higher rate of visualization of the CD in case of cholecystitis with mild adhesions, and an improved visualization of the HP, CBD, and CHD in case of severe inflammation, when compared to White Light observation. There were no benefits of NIR in case of non-inflamed lithiasis.
Clinical translation of NIR cholecystocholangiography has been successful with a noise-free visualization of biliary anatomy. It can be considered in difficult cases to increase the safety of laparoscopic cholecystectomy.
KeywordsNear-infrared cholangiography Direct intragallbladder Fluorophore injection
The authors are grateful to Christopher Burel and to Guy Temporal, professionals in medical English proofreading, for their valuable help in revising the manuscript.
Yu-Yin Liu, Chien-Hung Liao, and Michele Diana conceived and designed the study. Shang-Yu Wang and Chun-Nan Yeh made substantial contribution to data collection and analysis; Yu-Yin Liu, Michele Diana, Chien-Hung Liao, Seong-Ho Kong, and Bernard Dallemagne participated in drafting the article; Yu-Yin Liu, Michele Diana, Jacques Marescaux, and Ta-Sen Yeh revised the manuscript critically for important intellectual contents.
Compliance with ethical standards
This work was supported by Chang Gung Memorial Hospital through medical research grant CMRPG8F1171.
Jacques Marescaux is the President of both IRCAD and IHU Institutes, which are partly funded by Karl Storz, Medtronic, and Siemens Healthcare. Yu-Yin Liu, Chien-Hung Liao, Michele Diana, Shang-Yu Wang, Seong-Ho Kong, Chun-Nan Yeh, Bernard Dallemagne, and Ta-Sen Yeh have no conflicts of interest or financial ties to disclose.
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