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Erschienen in: Surgical Endoscopy 5/2020

15.07.2019

Routine near infra-red indocyanine green fluorescent cholangiography versus intraoperative cholangiography during laparoscopic cholecystectomy: a case-matched comparison

verfasst von: Silvia Quaresima, Andrea Balla, Livia Palmieri, Ardit Seitaj, Abe Fingerhut, Pietro Ursi, Alessandro M. Paganini

Erschienen in: Surgical Endoscopy | Ausgabe 5/2020

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Abstract

Background

The aim is to evaluate safety and efficacy of near infra-red (NIR) indocyanine green (ICG) fluorescence structural imaging during laparoscopic cholecystectomy (LC) (Group A) and to compare perioperative data, including operative time, with a series of patients who underwent LC with routine traditional intraoperative cholangiography (IOC) (Group B).

Methods

Forty-four patients with acute or chronic cholecystitis underwent NIR-ICG fluorescent cholangiography during LC. ICG was administered intravenously at different time intervals or by direct gallbladder injection during surgery. Fluorescence intensity and anatomy identification were scored according to a visual analogue scale between 1 (least accurate) and 5 (most accurate). Group B patients (n = 44) were chosen from a prospectively maintained database of patients who underwent LC with routine IOC, matched for age, sex, body mass index, and diagnosis with group A patients.

Results

No adverse reactions were recorded. In group A, mean time between intravenous administration of ICG and surgery was 10.7 ± 8.2 (range 2–52) h. Administered doses ranged from 3.5 to 13.5 mg. Fluorescence was present in all cases, scoring ≥ 3 in 41 patients. Mean operative time was 86.9 ± 36.9 (30–180) min in group A and 117.9 ± 43.4 (40–220) min in group B (p = 0.0006). No conversion to open surgery nor bile duct injuries were observed in either group.

Conclusions

LC with NIR-ICG fluorescent cholangiography is safe and effective for early recognition of anatomical landmarks, reducing operative time as compared to LC with IOC, even when residents were the main operator. NIR-ICG fluorescent cholangiography was effective in patients with acute cholecystitis and in the obese. Data collection into large registries on the results of NIR-ICG fluorescent cholangiography during LC should be encouraged to establish whether this technique might set a new safety standard for LC.
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Metadaten
Titel
Routine near infra-red indocyanine green fluorescent cholangiography versus intraoperative cholangiography during laparoscopic cholecystectomy: a case-matched comparison
verfasst von
Silvia Quaresima
Andrea Balla
Livia Palmieri
Ardit Seitaj
Abe Fingerhut
Pietro Ursi
Alessandro M. Paganini
Publikationsdatum
15.07.2019
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 5/2020
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06970-0

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