MINIMALLY INVASIVE CHOLECYSTECTOMY WITH INDOCYANINE GREEN FLUORESCENT CHOLANGIOGRAPHY – INITIAL EXPERIENCE
EAES Academy. Kyosev V. 07/05/22; 363047; P091
Dr. Vasil Kyosev
Contributions
Contributions
Abstract
Aims:
Last years in the surgical practice, indocyanine green (ICG) fluorescent cholangiography (FC) has been adopted to perform intra-operative biliary mapping and identify extrahepatic biliary anatomy during minimally invasive cholecystectomy (MIC). This study aimed to emphasise the use of ICG-FC in MIC and compare their results with MIC without use of ICG-FC.
Methods:
For period of one year (2019) in our unit were retrospectively reviewed 126 patients which underwent MIC. Pre-operative workup included laboratory blood tests and ultrasonography to assess main biliary tree. The ICG dosage in group with use of ICG-FC was 10 mg injections with time of administration 10-12 h prior to surgery. We evaluated three parameters in both groups: the total operative time (P1), the time of cystic duct disection, clipping and sectioning (P2), and the time of gallbladder release from hepatic fossa (P3). During surgery, imaging data were collected for analysis.
Results:
We operated 72 patients using standard technique (MIC) and 54 patients using ICG-FC (MIC+ICG). There were 68 females and 58 males, with median age at surgery of 57.6 years (range 23–81). No conversions were reported in our series. We observe more than 90% visualization of the cystic duct (CD), common bile duct (CBD), CD-CBD junction and the common hepatic duct (CHD) during dissection in MIC+ICG group. Intra-operative complications occurred in 11 MIC patients (15.3%): 5 bleedings from the Calot’s triangle, 2 partial damage to CBD and 4 bleeding from the liver bed during the gallbladder removal. MIC was significantly faster in all parameters (P1, P2, P3) in MIC+ICG group than in MIC group (p = 0.001).
Conclusions:
MIC-ICG is safe procedure and based upon our initial experience, we strongly recommend the use of ICG-FC in all patients undergoing MIC. ICG-guided fluorescence provided an excellent real-time visualization of the extrahepatic biliary tree and allowed faster and safer dissection, minimizing the risk of bile duct injuries.
Last years in the surgical practice, indocyanine green (ICG) fluorescent cholangiography (FC) has been adopted to perform intra-operative biliary mapping and identify extrahepatic biliary anatomy during minimally invasive cholecystectomy (MIC). This study aimed to emphasise the use of ICG-FC in MIC and compare their results with MIC without use of ICG-FC.
Methods:
For period of one year (2019) in our unit were retrospectively reviewed 126 patients which underwent MIC. Pre-operative workup included laboratory blood tests and ultrasonography to assess main biliary tree. The ICG dosage in group with use of ICG-FC was 10 mg injections with time of administration 10-12 h prior to surgery. We evaluated three parameters in both groups: the total operative time (P1), the time of cystic duct disection, clipping and sectioning (P2), and the time of gallbladder release from hepatic fossa (P3). During surgery, imaging data were collected for analysis.
Results:
We operated 72 patients using standard technique (MIC) and 54 patients using ICG-FC (MIC+ICG). There were 68 females and 58 males, with median age at surgery of 57.6 years (range 23–81). No conversions were reported in our series. We observe more than 90% visualization of the cystic duct (CD), common bile duct (CBD), CD-CBD junction and the common hepatic duct (CHD) during dissection in MIC+ICG group. Intra-operative complications occurred in 11 MIC patients (15.3%): 5 bleedings from the Calot’s triangle, 2 partial damage to CBD and 4 bleeding from the liver bed during the gallbladder removal. MIC was significantly faster in all parameters (P1, P2, P3) in MIC+ICG group than in MIC group (p = 0.001).
Conclusions:
MIC-ICG is safe procedure and based upon our initial experience, we strongly recommend the use of ICG-FC in all patients undergoing MIC. ICG-guided fluorescence provided an excellent real-time visualization of the extrahepatic biliary tree and allowed faster and safer dissection, minimizing the risk of bile duct injuries.
Aims:
Last years in the surgical practice, indocyanine green (ICG) fluorescent cholangiography (FC) has been adopted to perform intra-operative biliary mapping and identify extrahepatic biliary anatomy during minimally invasive cholecystectomy (MIC). This study aimed to emphasise the use of ICG-FC in MIC and compare their results with MIC without use of ICG-FC.
Methods:
For period of one year (2019) in our unit were retrospectively reviewed 126 patients which underwent MIC. Pre-operative workup included laboratory blood tests and ultrasonography to assess main biliary tree. The ICG dosage in group with use of ICG-FC was 10 mg injections with time of administration 10-12 h prior to surgery. We evaluated three parameters in both groups: the total operative time (P1), the time of cystic duct disection, clipping and sectioning (P2), and the time of gallbladder release from hepatic fossa (P3). During surgery, imaging data were collected for analysis.
Results:
We operated 72 patients using standard technique (MIC) and 54 patients using ICG-FC (MIC+ICG). There were 68 females and 58 males, with median age at surgery of 57.6 years (range 23–81). No conversions were reported in our series. We observe more than 90% visualization of the cystic duct (CD), common bile duct (CBD), CD-CBD junction and the common hepatic duct (CHD) during dissection in MIC+ICG group. Intra-operative complications occurred in 11 MIC patients (15.3%): 5 bleedings from the Calot’s triangle, 2 partial damage to CBD and 4 bleeding from the liver bed during the gallbladder removal. MIC was significantly faster in all parameters (P1, P2, P3) in MIC+ICG group than in MIC group (p = 0.001).
Conclusions:
MIC-ICG is safe procedure and based upon our initial experience, we strongly recommend the use of ICG-FC in all patients undergoing MIC. ICG-guided fluorescence provided an excellent real-time visualization of the extrahepatic biliary tree and allowed faster and safer dissection, minimizing the risk of bile duct injuries.
Last years in the surgical practice, indocyanine green (ICG) fluorescent cholangiography (FC) has been adopted to perform intra-operative biliary mapping and identify extrahepatic biliary anatomy during minimally invasive cholecystectomy (MIC). This study aimed to emphasise the use of ICG-FC in MIC and compare their results with MIC without use of ICG-FC.
Methods:
For period of one year (2019) in our unit were retrospectively reviewed 126 patients which underwent MIC. Pre-operative workup included laboratory blood tests and ultrasonography to assess main biliary tree. The ICG dosage in group with use of ICG-FC was 10 mg injections with time of administration 10-12 h prior to surgery. We evaluated three parameters in both groups: the total operative time (P1), the time of cystic duct disection, clipping and sectioning (P2), and the time of gallbladder release from hepatic fossa (P3). During surgery, imaging data were collected for analysis.
Results:
We operated 72 patients using standard technique (MIC) and 54 patients using ICG-FC (MIC+ICG). There were 68 females and 58 males, with median age at surgery of 57.6 years (range 23–81). No conversions were reported in our series. We observe more than 90% visualization of the cystic duct (CD), common bile duct (CBD), CD-CBD junction and the common hepatic duct (CHD) during dissection in MIC+ICG group. Intra-operative complications occurred in 11 MIC patients (15.3%): 5 bleedings from the Calot’s triangle, 2 partial damage to CBD and 4 bleeding from the liver bed during the gallbladder removal. MIC was significantly faster in all parameters (P1, P2, P3) in MIC+ICG group than in MIC group (p = 0.001).
Conclusions:
MIC-ICG is safe procedure and based upon our initial experience, we strongly recommend the use of ICG-FC in all patients undergoing MIC. ICG-guided fluorescence provided an excellent real-time visualization of the extrahepatic biliary tree and allowed faster and safer dissection, minimizing the risk of bile duct injuries.
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