Fluorescence cholangiography - a clinical case series
DOI:
https://doi.org/10.5281/zenodo.14866570Keywords:
biliary duct injuries, laparoscopic cholecystectomy, fluorescence cholangiography, indocyanine green (ICG)Abstract
Introduction: Bile duct injuries (BDI) during laparoscopic cholecystectomy have potentially catastrophic consequences when not identified intraoperatively. The incidence varies widely, with a reported annual incidence of 0.15% to 0.3% in the United States with approximately 1,000,000 cholecystectomies performed annually.
According to the literature, in up to 90% of cases the cause of BDI is poor visualization of the structures in the Calot's triangle. Fluorescence cholangiography with indocyanine green (ICG) is a modern method that allows visualization of the extrahepatic bile ducts (EHBD) in the triangle of Calot before dissection is started. In 2022, the first consensus conference statement on the use of near-infrared fluorescence imaging and indocyanine green guided surgery conducted on Delphi survey basis was published. It reached a consensus that fluores cence cholangiography is safe and routine use is recommended. In addition, the method can be used for training purposes of graduate students. Since no exact time range is mentioned in the guideline, the aim of the present study was to perform the ICG injection at three different time intervals before surgery – 1, 3 and 6 hours, in order to achieve optimal visualization.
Clinical cases: We present 3 cases of laparoscopic cholecystectomy with fluorescence cholangiography performed for safe dissection of structures in the triangle of Calot. ICG solution with a concentration of 2.5 mg/ml was used. Cholangiography was performed with preoperative injection of 0.05 ml/kg of the dye at three different time points - 1, 3 and 6 hours before the skin incision.
Discussion and Conclusion: BDIs are complications that are sometimes extremely difficult to manage and may require the involvement of a hepatobiliary surgeon. Even timely recognized lesions and primary repair performed are sometimes unsuccessful. Unrecognized in time, this type of iatrogenia is potentially lethal. Fluorescence cholangiography with ICG is a new method that improves safety during laparoscopic cholecystectomy and is also finding application in surgical training.More research is needed to clarify the optimal time range for dye application before surgery.
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Copyright (c) 2023 Tsanko Yotsov, P. Kamenova, A. Vricheva, M. Karamanliev, Pl. Сhernopolski, D. Dimitrov (Author)
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