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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 |
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| container_title | Surgery today (Tokyo, Japan) |
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| creator | 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 |
| description | 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
|
| doi_str_mv | 10.1007/s00595-022-02563-y |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2697674742</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2697674742</sourcerecordid><originalsourceid>FETCH-LOGICAL-c371t-2d5cebda8d35a49bf71f7304ffd7432b213e642392ff5a981ec995cc3088d4b83</originalsourceid><addsrcrecordid>eNp9Uctu1TAQtRCI3l74ARbISzYpfuRldqjiJVVCQrC2HGdy48qJg-2AwtfwLd31rxjuLWwqdWGNNTPnzJk5hLzg7IIz1rxOjFWqKpgQ-KpaFtsjsuOlrAvRcvmY7JgqecGF4mfkPKVrxkTZMvaUnMlKCaZkvSO3X8D4IrsJ6ODXECFZmDO1Y_BmPrhwiGYZN_rT5ZG6uQ92M7ObgR4iwIwZ6s1iYkg2LM4eYWC3lMHmMG1vqKHRIGpyv6CnNsw5Bu_xm6MznuZAIWXTeZdGmkegYUElWLg_qQ8JjipwpGQ3vyeMS4SwQDTZ_QC_PSNPBuMTPL-Le_Lt_buvlx-Lq88fPl2-vSqsbHguRF9Z6HrT9rIypeqGhg-NZOUw9E0pRSe4hLoUUolhqIxqOVilKmsla9u-7Fq5J69OvEsM31fUryeHR_N4Lwhr0qJWTd2UDXLsiTi1WrxQijDoJeJ-cdOc6b8W6pOFGi3URwv1hqCXd_xrN0H_H_LPM2yQp4aEpfkAUV-HNc6480O0fwBUcK94</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2697674742</pqid></control><display><type>article</type><title>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</title><source>Springer Nature</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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
< 0.05). When setting the ideal cholangiography at a BLR ≥ 1, ≥ 3, or ≥ 5, the 0.1-mg group showed the highest qualified case number at the three timepoints.
Conclusions
The intravenous administration of 0.1-mg ICG, 30 min before LC, is significantly better for fluorescent cholangiography of the extrahepatic biliary structures before dissection and clipping of the cystohepatic triangle.
Trial registration
This study was registered in the Chinese Clinical Trial Registry (ChiCTR) (ChiCTR2200057933).</description><identifier>ISSN: 0941-1291</identifier><identifier>EISSN: 1436-2813</identifier><identifier>DOI: 10.1007/s00595-022-02563-y</identifier><identifier>PMID: 35920936</identifier><language>eng</language><publisher>Singapore: Springer Nature Singapore</publisher><subject>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</subject><ispartof>Surgery today (Tokyo, Japan), 2023-02, Vol.53 (2), p.223-231</ispartof><rights>The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd. 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c371t-2d5cebda8d35a49bf71f7304ffd7432b213e642392ff5a981ec995cc3088d4b83</citedby><cites>FETCH-LOGICAL-c371t-2d5cebda8d35a49bf71f7304ffd7432b213e642392ff5a981ec995cc3088d4b83</cites><orcidid>0000-0003-0518-9239 ; 0000-0002-0882-3058 ; 0000-0002-0448-110X ; 0000-0002-6788-6366 ; 0000-0002-6668-0702</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35920936$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huang, Yu</creatorcontrib><creatorcontrib>Chen, Qiangxing</creatorcontrib><creatorcontrib>Kuang, Jiao</creatorcontrib><creatorcontrib>Zhang, Shuai</creatorcontrib><creatorcontrib>Weng, Jiefeng</creatorcontrib><creatorcontrib>Lai, Yueyuan</creatorcontrib><creatorcontrib>Liu, Hui</creatorcontrib><creatorcontrib>Wu, Zhaofeng</creatorcontrib><creatorcontrib>Huang, Di</creatorcontrib><creatorcontrib>Lin, Fan</creatorcontrib><creatorcontrib>Zhu, Guanghui</creatorcontrib><creatorcontrib>Cao, Tiansheng</creatorcontrib><creatorcontrib>Gu, Weili</creatorcontrib><title>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</title><title>Surgery today (Tokyo, Japan)</title><addtitle>Surg Today</addtitle><addtitle>Surg Today</addtitle><description>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
< 0.05). When setting the ideal cholangiography at a BLR ≥ 1, ≥ 3, or ≥ 5, the 0.1-mg group showed the highest qualified case number at the three timepoints.
Conclusions
The intravenous administration of 0.1-mg ICG, 30 min before LC, is significantly better for fluorescent cholangiography of the extrahepatic biliary structures before dissection and clipping of the cystohepatic triangle.
Trial registration
This study was registered in the Chinese Clinical Trial Registry (ChiCTR) (ChiCTR2200057933).</description><subject>Bile Ducts, Extrahepatic</subject><subject>chictr</subject><subject>ChiCTR-text-2200057933</subject><subject>Cholangiography - methods</subject><subject>Cholecystectomy, Laparoscopic - methods</subject><subject>Coloring Agents</subject><subject>Humans</subject><subject>Indocyanine Green</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><issn>0941-1291</issn><issn>1436-2813</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9Uctu1TAQtRCI3l74ARbISzYpfuRldqjiJVVCQrC2HGdy48qJg-2AwtfwLd31rxjuLWwqdWGNNTPnzJk5hLzg7IIz1rxOjFWqKpgQ-KpaFtsjsuOlrAvRcvmY7JgqecGF4mfkPKVrxkTZMvaUnMlKCaZkvSO3X8D4IrsJ6ODXECFZmDO1Y_BmPrhwiGYZN_rT5ZG6uQ92M7ObgR4iwIwZ6s1iYkg2LM4eYWC3lMHmMG1vqKHRIGpyv6CnNsw5Bu_xm6MznuZAIWXTeZdGmkegYUElWLg_qQ8JjipwpGQ3vyeMS4SwQDTZ_QC_PSNPBuMTPL-Le_Lt_buvlx-Lq88fPl2-vSqsbHguRF9Z6HrT9rIypeqGhg-NZOUw9E0pRSe4hLoUUolhqIxqOVilKmsla9u-7Fq5J69OvEsM31fUryeHR_N4Lwhr0qJWTd2UDXLsiTi1WrxQijDoJeJ-cdOc6b8W6pOFGi3URwv1hqCXd_xrN0H_H_LPM2yQp4aEpfkAUV-HNc6480O0fwBUcK94</recordid><startdate>20230201</startdate><enddate>20230201</enddate><creator>Huang, Yu</creator><creator>Chen, Qiangxing</creator><creator>Kuang, Jiao</creator><creator>Zhang, Shuai</creator><creator>Weng, Jiefeng</creator><creator>Lai, Yueyuan</creator><creator>Liu, Hui</creator><creator>Wu, Zhaofeng</creator><creator>Huang, Di</creator><creator>Lin, Fan</creator><creator>Zhu, Guanghui</creator><creator>Cao, Tiansheng</creator><creator>Gu, Weili</creator><general>Springer Nature Singapore</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0518-9239</orcidid><orcidid>https://orcid.org/0000-0002-0882-3058</orcidid><orcidid>https://orcid.org/0000-0002-0448-110X</orcidid><orcidid>https://orcid.org/0000-0002-6788-6366</orcidid><orcidid>https://orcid.org/0000-0002-6668-0702</orcidid></search><sort><creationdate>20230201</creationdate><title>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</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c371t-2d5cebda8d35a49bf71f7304ffd7432b213e642392ff5a981ec995cc3088d4b83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Bile Ducts, Extrahepatic</topic><topic>chictr</topic><topic>ChiCTR-text-2200057933</topic><topic>Cholangiography - methods</topic><topic>Cholecystectomy, Laparoscopic - methods</topic><topic>Coloring Agents</topic><topic>Humans</topic><topic>Indocyanine Green</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huang, Yu</creatorcontrib><creatorcontrib>Chen, Qiangxing</creatorcontrib><creatorcontrib>Kuang, Jiao</creatorcontrib><creatorcontrib>Zhang, Shuai</creatorcontrib><creatorcontrib>Weng, Jiefeng</creatorcontrib><creatorcontrib>Lai, Yueyuan</creatorcontrib><creatorcontrib>Liu, Hui</creatorcontrib><creatorcontrib>Wu, Zhaofeng</creatorcontrib><creatorcontrib>Huang, Di</creatorcontrib><creatorcontrib>Lin, Fan</creatorcontrib><creatorcontrib>Zhu, Guanghui</creatorcontrib><creatorcontrib>Cao, Tiansheng</creatorcontrib><creatorcontrib>Gu, Weili</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery today (Tokyo, Japan)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huang, Yu</au><au>Chen, Qiangxing</au><au>Kuang, Jiao</au><au>Zhang, Shuai</au><au>Weng, Jiefeng</au><au>Lai, Yueyuan</au><au>Liu, Hui</au><au>Wu, Zhaofeng</au><au>Huang, Di</au><au>Lin, Fan</au><au>Zhu, Guanghui</au><au>Cao, Tiansheng</au><au>Gu, Weili</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Surgery today (Tokyo, Japan)</jtitle><stitle>Surg Today</stitle><addtitle>Surg Today</addtitle><date>2023-02-01</date><risdate>2023</risdate><volume>53</volume><issue>2</issue><spage>223</spage><epage>231</epage><pages>223-231</pages><issn>0941-1291</issn><eissn>1436-2813</eissn><abstract>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
< 0.05). When setting the ideal cholangiography at a BLR ≥ 1, ≥ 3, or ≥ 5, the 0.1-mg group showed the highest qualified case number at the three timepoints.
Conclusions
The intravenous administration of 0.1-mg ICG, 30 min before LC, is significantly better for fluorescent cholangiography of the extrahepatic biliary structures before dissection and clipping of the cystohepatic triangle.
Trial registration
This study was registered in the Chinese Clinical Trial Registry (ChiCTR) (ChiCTR2200057933).</abstract><cop>Singapore</cop><pub>Springer Nature Singapore</pub><pmid>35920936</pmid><doi>10.1007/s00595-022-02563-y</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0518-9239</orcidid><orcidid>https://orcid.org/0000-0002-0882-3058</orcidid><orcidid>https://orcid.org/0000-0002-0448-110X</orcidid><orcidid>https://orcid.org/0000-0002-6788-6366</orcidid><orcidid>https://orcid.org/0000-0002-6668-0702</orcidid></addata></record> |
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| ispartof | Surgery today (Tokyo, Japan), 2023-02, Vol.53 (2), p.223-231 |
| issn | 0941-1291 1436-2813 |
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| source | Springer Nature |
| 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 |
| title | 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 |
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