The role of ICG imaging guidance in difficult laparoscopic cholecystectomy

Abstract

Abstract: Objective To evaluate the clinical utility of indocyanine green (ICG) fluorescence imaging guidance in facilitating difficult laparoscopic cholecystectomy. Methods A total of 60 patients undergoing difficult laparoscopic cholecystectomy were enrolled between May 2022 and May 2023, comprising 35 males and 25 females, with a mean age of 53.6±2.1 years. The patients were divided into two groups based on the use of ICG imaging guidance during surgery: the observation group (n=35) utilized ICG fluorescence imaging for extrahepatic bile duct visualization, while the control group (n=25) used standard white light imaging. Clinical outcomes and complication rates between the two groups were compared. Results In the observation group, the operating time, intraoperative blood loss, hospital stay, hospital cost, and percentage of four-port laparoscopic cholecystectomy were 75.1±12.8 minutes, 17.6±6.6 mL, 2.8±1.2 days, ￥10,125.2±902.3, and 28.6%, respectively. These values were significantly lower than those in the control group, which were105.6±18.9 minutes, 23.7±8.6 mL, 3.6±1.8 days, ￥10859.6±1405.3, and 80.0%(t/χ²=7.590、7.015、6.837、2.557 and 15.429, respectively; P<0.05). The incidence of bleeding, pulmonary infection, biliary fistula and bile duct injury in the observation group was 0(0%), 1 case (2.9%), 0(0%) and 0(0%) respectively, compared to 1 case (4.0%), 2 cases (8.0%) and 1 case (4.0%) in the control group. The total complication rate between the two groups was statistically significant (χ²=6.326, P=0.012). Conclusion Difficult laparoscopic cholecystectomy poses a higher risk of bile duct injury due to unclear anatomical structures and anatomical variationss. ICG fluorescence imaging significantly enhances the visualization of bile duct structures, reduces operation time and intraoperative blood loss, helps prevent bile duct injury and decreases postoperative complications. Therefore, it is a valuable technique that merits wider adoption in clinical practice.

Key words: Indocyanine green, Difficult laparoscopic cholecystectomy

ZHAO Jie, ZHOU Jian-gang, YANG Yong, SHAO Rong. The role of ICG imaging guidance in difficult laparoscopic cholecystectomy[J]. Chinese Hepatolgy, 2024, 29(10): 1274-1276.

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