Real-time fluorescent cholangiography with indocyanine green in laparoscopic cholecystectomy: a randomized controlled trial to establish the optimal indocyanine green dose within 30 min preoperatively

Purpose To establish the optimal dose of indocyanine green (ICG) to administer intravenously 30 min before laparoscopic cholecystectomy (LC). Methods In this randomized controlled trial (RCT), patients undergoing LC for cholecystitis, cholelithiasis, and/or cholecystic polyps were randomized into fo...

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Published in:Surgery today (Tokyo, Japan) Japan), 2023-02, Vol.53 (2), p.223-231
Main Authors: Huang, Yu, Chen, Qiangxing, Kuang, Jiao, Zhang, Shuai, Weng, Jiefeng, Lai, Yueyuan, Liu, Hui, Wu, Zhaofeng, Huang, Di, Lin, Fan, Zhu, Guanghui, Cao, Tiansheng, Gu, Weili
Format: Article
Language:English
Subjects:
Bile Ducts, Extrahepatic
chictr
ChiCTR-text-2200057933
Cholangiography - methods
Cholecystectomy, Laparoscopic - methods
Coloring Agents
Humans
Indocyanine Green
Medicine
Medicine & Public Health
Original Article
Surgery
Surgical Oncology
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Summary:Purpose To establish the optimal dose of indocyanine green (ICG) to administer intravenously 30 min before laparoscopic cholecystectomy (LC). Methods In this randomized controlled trial (RCT), patients undergoing LC for cholecystitis, cholelithiasis, and/or cholecystic polyps were randomized into four groups given four different ICG doses (0.025, 0.1, 0.25, 2.5 mg). Using OptoMedic endoscopy combined with a near-infrared fluorescent imaging system, we evaluated the fluorescence intensity (FI) of the common bile duct and liver at three timepoints: before surgical dissection of the cystohepatic triangle, before clipping of the cystic duct, and before closure. The bile duct-to-liver ratio (BLR) of the FI was analyzed to assess the cholangiography effect. Results Sixty-four patients were allocated to one of four groups, with 40 patients included in the final analysis. Generally, with increasing ICG doses, the levels of FI in the bile duct and liver increased gradually at each of the three timepoints. Before surgical dissection of the cystohepatic triangle, 0.1-mg ICG showed the highest BLR ( F  = 3.47, p  = 0.0259). Before clipping the cystic duct and before closure, the 0.025- and 0.1-mg groups showed a higher BLR than the 0.25- and 2.5-mg groups ( p  
ISSN:0941-1291
1436-2813
DOI:10.1007/s00595-022-02563-y