Surgical Endoscopy

, Volume 32, Issue 3, pp 1506–1514 | Cite as

Near-infrared cholecystocholangiography with direct intragallbladder indocyanine green injection: preliminary clinical results

  • Yu-Yin Liu
  • Chien-Hung Liao
  • Michele Diana
  • Shang-Yu Wang
  • Seong-Ho Kong
  • Chun-Nan Yeh
  • Bernard Dallemagne
  • Jacques Marescaux
  • Ta-Sen Yeh
Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Near-infrared cholangiography Direct intragallbladder Fluorophore injection 

Notes

Acknowledgements

The authors are grateful to Christopher Burel and to Guy Temporal, professionals in medical English proofreading, for their valuable help in revising the manuscript.

Authors’ contribution

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

Funding

This work was supported by Chang Gung Memorial Hospital through medical research grant CMRPG8F1171.

Disclosures

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.

Supplementary material

Supplementary material 1 (MOV 94968 kb)

Supplementary material 2 (MOV 92209 kb)

Supplementary material 3 (MOV 95615 kb)

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of General Surgery, Chang Gung Memorial Hospital, LinkouChang Gung UniversityTaoyuanTaiwan
  2. 2.Department of General Surgery, Chang Gung Memorial Hospital, KaohsiungChang Gung UniversityKaohsiungTaiwan
  3. 3.IRCAD, Research Institute Against Cancer of the Digestive SystemStrasbourgFrance
  4. 4.Institute of Image-Guided SurgeryIHU-StrasbourgStrasbourgFrance
  5. 5.Department of SurgerySeoul National University HospitalSeoulSouth Korea

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