Fluorescent Imaging with Indocyanine Green during Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury

Marjolein Ankersmit, Dieuwertje A. Van Dam, Anne Sophie Van Rijswijk, Baukje Van Den Heuvel, Jurriaan B. Tuynman, Wilhelmus J.H.J. Meijerink

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background. Although rare, injury to the common bile duct (CBD) during laparoscopic cholecystectomy (LC) can be reduced by better intraoperative visualization of the cystic duct (CD) and CBD. The aim of this study was to establish the efficacy of early visualization of the CD and the added value of CBD identification, using near-infrared (NIR) light and the fluorescent agent indocyanine green (ICG), in patients at increased risk of bile duct injury. Materials and Methods. Patients diagnosed with complicated cholecystitis and scheduled for LC were included. The CBD and CD were visualized with NIR light before and during dissection of the liver hilus and at critical view of safety (CVS). Results. Of the 20 patients originally included, 2 were later excluded due to conversion. In 6 of 18 patients, the CD was visualized early during dissection and prior to imaging with conventional white light. The CBD was additionally visualized with ICG-NIR in 7 of 18 patients. In 1 patient, conversion was prevented due to detection of the CD and CBD with ICG-NIR. Conclusions. Early visualization of the CD or additional identification of the CBD using ICG-NIR in patients with complicated cholecystolithiasis can be helpful in preventing CBD injury. Future studies should attempt to establish the optimal dosage and time frame for ICG administration and bile duct visualization with respect to different gallbladder pathologies.

Original languageEnglish
Pages (from-to)245-252
Number of pages8
JournalSurgical Innovation
Volume24
Issue number3
DOIs
Publication statusPublished - 2017

Cite this

@article{f23448fcc80d4bf38bd80537a6270164,
title = "Fluorescent Imaging with Indocyanine Green during Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury",
abstract = "Background. Although rare, injury to the common bile duct (CBD) during laparoscopic cholecystectomy (LC) can be reduced by better intraoperative visualization of the cystic duct (CD) and CBD. The aim of this study was to establish the efficacy of early visualization of the CD and the added value of CBD identification, using near-infrared (NIR) light and the fluorescent agent indocyanine green (ICG), in patients at increased risk of bile duct injury. Materials and Methods. Patients diagnosed with complicated cholecystitis and scheduled for LC were included. The CBD and CD were visualized with NIR light before and during dissection of the liver hilus and at critical view of safety (CVS). Results. Of the 20 patients originally included, 2 were later excluded due to conversion. In 6 of 18 patients, the CD was visualized early during dissection and prior to imaging with conventional white light. The CBD was additionally visualized with ICG-NIR in 7 of 18 patients. In 1 patient, conversion was prevented due to detection of the CD and CBD with ICG-NIR. Conclusions. Early visualization of the CD or additional identification of the CBD using ICG-NIR in patients with complicated cholecystolithiasis can be helpful in preventing CBD injury. Future studies should attempt to establish the optimal dosage and time frame for ICG administration and bile duct visualization with respect to different gallbladder pathologies.",
keywords = "image-guided surgery, simulation, surgical education",
author = "Marjolein Ankersmit and {Van Dam}, {Dieuwertje A.} and {Van Rijswijk}, {Anne Sophie} and {Van Den Heuvel}, Baukje and Tuynman, {Jurriaan B.} and Meijerink, {Wilhelmus J.H.J.}",
year = "2017",
doi = "10.1177/1553350617690309",
language = "English",
volume = "24",
pages = "245--252",
journal = "Surgical Innovation",
issn = "1553-3506",
publisher = "SAGE Publications Inc.",
number = "3",

}

Fluorescent Imaging with Indocyanine Green during Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury. / Ankersmit, Marjolein; Van Dam, Dieuwertje A.; Van Rijswijk, Anne Sophie; Van Den Heuvel, Baukje; Tuynman, Jurriaan B.; Meijerink, Wilhelmus J.H.J.

In: Surgical Innovation, Vol. 24, No. 3, 2017, p. 245-252.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Fluorescent Imaging with Indocyanine Green during Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury

AU - Ankersmit, Marjolein

AU - Van Dam, Dieuwertje A.

AU - Van Rijswijk, Anne Sophie

AU - Van Den Heuvel, Baukje

AU - Tuynman, Jurriaan B.

AU - Meijerink, Wilhelmus J.H.J.

PY - 2017

Y1 - 2017

N2 - Background. Although rare, injury to the common bile duct (CBD) during laparoscopic cholecystectomy (LC) can be reduced by better intraoperative visualization of the cystic duct (CD) and CBD. The aim of this study was to establish the efficacy of early visualization of the CD and the added value of CBD identification, using near-infrared (NIR) light and the fluorescent agent indocyanine green (ICG), in patients at increased risk of bile duct injury. Materials and Methods. Patients diagnosed with complicated cholecystitis and scheduled for LC were included. The CBD and CD were visualized with NIR light before and during dissection of the liver hilus and at critical view of safety (CVS). Results. Of the 20 patients originally included, 2 were later excluded due to conversion. In 6 of 18 patients, the CD was visualized early during dissection and prior to imaging with conventional white light. The CBD was additionally visualized with ICG-NIR in 7 of 18 patients. In 1 patient, conversion was prevented due to detection of the CD and CBD with ICG-NIR. Conclusions. Early visualization of the CD or additional identification of the CBD using ICG-NIR in patients with complicated cholecystolithiasis can be helpful in preventing CBD injury. Future studies should attempt to establish the optimal dosage and time frame for ICG administration and bile duct visualization with respect to different gallbladder pathologies.

AB - Background. Although rare, injury to the common bile duct (CBD) during laparoscopic cholecystectomy (LC) can be reduced by better intraoperative visualization of the cystic duct (CD) and CBD. The aim of this study was to establish the efficacy of early visualization of the CD and the added value of CBD identification, using near-infrared (NIR) light and the fluorescent agent indocyanine green (ICG), in patients at increased risk of bile duct injury. Materials and Methods. Patients diagnosed with complicated cholecystitis and scheduled for LC were included. The CBD and CD were visualized with NIR light before and during dissection of the liver hilus and at critical view of safety (CVS). Results. Of the 20 patients originally included, 2 were later excluded due to conversion. In 6 of 18 patients, the CD was visualized early during dissection and prior to imaging with conventional white light. The CBD was additionally visualized with ICG-NIR in 7 of 18 patients. In 1 patient, conversion was prevented due to detection of the CD and CBD with ICG-NIR. Conclusions. Early visualization of the CD or additional identification of the CBD using ICG-NIR in patients with complicated cholecystolithiasis can be helpful in preventing CBD injury. Future studies should attempt to establish the optimal dosage and time frame for ICG administration and bile duct visualization with respect to different gallbladder pathologies.

KW - image-guided surgery

KW - simulation

KW - surgical education

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U2 - 10.1177/1553350617690309

DO - 10.1177/1553350617690309

M3 - Article

VL - 24

SP - 245

EP - 252

JO - Surgical Innovation

JF - Surgical Innovation

SN - 1553-3506

IS - 3

ER -