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Erschienen in:

22.02.2022

Routine use of ICG to enhance operative safety in emergency laparoscopic cholecystectomy: a randomized controlled trial

verfasst von: Wong Hoi She, Tan To Cheung, Miu Yee Chan, Ka Wan Chu, Ka Wing Ma, Simon H. Y. Tsang, Wing Chiu Dai, Albert C. Y. Chan, Chung Mau Lo

Erschienen in: Surgical Endoscopy | Ausgabe 6/2022

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Abstract

Objective

To test the hypothesis that ICG fluorescence cholangiography (ICG-FC) helps to identify critical structures during laparoscopic cholecystectomy (LC) and hence reduce biliary injuries and conversions.

Summary background data

In LC, biliary injury and conversion often happen if the biliary anatomy is misidentified.

Methods

This was a single-center randomized controlled trial from 2017 to 2019. Patients with acute cholecystitis requiring LC were assessed for eligibility for the trial. Patients in the trial were randomized to undergo either conventional LC (conventional arm) or LC with ICG-FC (ICG arm). Conversion rate and biliary injury incidence were outcome measures.

Results

Totally 92 patients participated (46 patients in each arm). The median age was 61 years in both arms (p = 0.472). The conventional arm had 22 men and 24 women; the ICG arm had 24 men and 22 women (p = 0.677). The two arms were comparable in all perioperative parameters. The time from ICG injection to surgery was 67 (16–1150) min. Both arms had an 8.7% conversion rate (p = 1.000). The median operative time was 140.5 min in the conventional arm and 149.5 min in the ICG arm (p = 0.086). The complication rate was 15.2% in the former and 10.9% in the latter (p = 0.536), and both had a 2.2% bile leakage rate. The median hospital stay was 3.5d in the former and 4.0d in the latter (p = 0.380).

Conclusion

ICG-FC did not make any difference in conversion or complication rate. Its routine use in LC is questionable. However, it may be helpful in difficult cholecystectomies and may be used as an adjunct.

Trial registration

The trial was registered with the Institutional Review Board of University of Hong Kong/Hospital Authority Hong Kong West Cluster (http://www.med.hku.hk/en/research/ethics-and-integrity/human-ethics). Registration number: UW17-492.

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Titel: Routine use of ICG to enhance operative safety in emergency laparoscopic cholecystectomy: a randomized controlled trial
verfasst von: Wong Hoi She
Tan To Cheung
Miu Yee Chan
Ka Wan Chu
Ka Wing Ma
Simon H. Y. Tsang
Wing Chiu Dai
Albert C. Y. Chan
Chung Mau Lo
Publikationsdatum: 22.02.2022
Verlag: Springer US
Erschienen in: Surgical Endoscopy / Ausgabe 6/2022
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-021-08795-2

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