Fluorescent cholangiography with direct injection of indocyanine green (ICG) into the gallbladder: a safety method to ou
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ORIGINAL ARTICLE
Fluorescent cholangiography with direct injection of indocyanine green (ICG) into the gallbladder: a safety method to outline biliary anatomy Clara Gené Škrabec 1 & Fernando Pardo Aranda 1 Alba Zárate 1 & Esteban Cugat 1,2
&
Francisco Espín 1 & Manel Cremades 1 & Jordi Navinés 1 &
Received: 8 May 2020 / Accepted: 12 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Near infrared cholangiography (NIRC) with indocyanine green (ICG) directly injected into the gallbladder is a novel technique to outline biliary anatomy. The purpose of this article is to analyze the usefulness and feasibility of NIRC as a safety method during laparoscopic cholecystectomies. Material and methods A case-controlled study comparing 20 patients undergoing laparoscopic cholecystectomies with NIRC with direct injection of ICG into the gallbladder to 20 consecutive standard cholecystectomies. Operative time, length of stay, complications, conversion rates, and biliary injury were analyzed. Results Both groups were comparable in epidemiological characteristics. In the ICG group fluorescent visualization of the junction of the Hartmann pouch and the whole cystic duct was achieved in 16 (80%) patients. Median surgical time was 65 (50–76) and 55 (45–71) min for the ICG and the control group, respectively (p = 0.113). There were no postoperative complications and no biliary duct injuries in any of the groups, and a patient from both groups underwent conversion to open surgery. Conclusion NIRC with direct injection of ICG into the gallbladder is a feasible method that is not time-consuming; it does not require a different learning curve from standard laparoscopic cholecystectomies and has no major complications described so far. Keywords Indocyanine green . NIRC . Laparoscopic cholecystectomies . Patient safety
Introduction Laparoscopic cholecystectomies are one of the most frequently performed surgeries in a General and Digestive Surgery Department worldwide. Over 750,000 cholecystectomies are performed each year in the USA [1]. According to the CMBD (Conjunto Mínimo Básico de Datos) of the Spanish National Health system in 2017, 78,567 cholecystectomies were Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01967-z) contains supplementary material, which is available to authorized users. * Fernando Pardo Aranda [email protected] 1
Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
2
Department of General and Digestive Surgery, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
performed in Spain, of which 86.4% were laparoscopic cholecystectomies [2]. Bile duct injury remains one of the most feared complications related to cholecystectomies. With varying severity, total incidence of iatrogenic biliary lesions ranges from 0.08 to 1.5% [3]. Since laparoscopic cholecystectomies are so common, there are thousands of patients every year that suffer these compl
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