Near-infrared cholecysto-cholangiography with indocyanine green may secure cholecystectomy in difficult clinical situations: proof of the concept in a porcine model

Yu Yin Liu, Seong Ho Kong, Michele Diana, Andras Lègner, Chun Chi Wu, Noriaki Kameyama, Bernard Dallemagne, Jacques Marescaux

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Biliary injuries remain a major concern in laparoscopic cholecystectomy. New intraoperative guidance modalities, including near-infrared fluorescence cholangiography, are under evaluation. Initial results showed limitations in visualizing the biliary tree in specific clinical situations. The aim of this study was to examine the feasibility and potentiality of fluorescence cholecysto-cholangiography performed with a direct injection of indocyanine green (ICG) in the gallbladder and to compare it to systemic injection in such situations. Materials and methods: Seven pigs were included in this non-survival study. In two pigs, the gallbladder was punctured by a percutaneous needle, and 1 mL of ICG in different concentrations (0.001, 0.01, 0.1, and 1 mg/mL) was sequentially injected. Visibility and pattern of the fluorescent signal around Calot’s triangle were examined and compared with those of two control pigs receiving 2.5 mg of intravenous ICG, 30 min prior to the operation. Different scenarios of cholecystitis were modeled using an injection of a mixture of blood and agarose gel around Calot’s triangle area in the remaining three pigs, and the applicability of direct intragallbladder injection methods was evaluated. Results: The fluorescent signal was identified immediately after intragallbladder injection, and the cystic duct became visible by 0.1 and 1 mg/mL of ICG. The whole cystic duct and the infundibulum of the gallbladder were clearly enhanced by intragallbladder ICG injection, but not by systemic injection. In the cholecystitis models, the cystic duct could be identified only after partial dissection, and fluorescence visualization of the gallbladder infundibulum provided crucial information to find the correct starting point of dissection. Conclusions: Fluorescence cholecysto-cholangiography through direct intragallbladder ICG injection could rapidly provide an adequate visualization of gallbladder neck and cystic duct and might be a valid option to increase the safety of cholecystectomy in case of cholecystitis.

Original languageEnglish
Pages (from-to)4115-4123
Number of pages9
JournalSurgical Endoscopy
Volume30
Issue number9
DOIs
StatePublished - 1 Sep 2016

Fingerprint

Indocyanine Green
Cholangiography
Cholecystectomy
Swine
Cystic Duct
Gallbladder
Injections
Cholecystitis
Fluorescence
Pituitary Gland
Dissection
Laparoscopic Cholecystectomy
Biliary Tract
Sepharose
Needles
Gels
Safety
Wounds and Injuries

Keywords

  • Cholecystitis
  • Common bile duct injury
  • Fluorescence-guided surgery
  • Indocyanine green (ICG)
  • Laparoscopic cholecystectomy
  • Near-infrared cholangiography
  • Near-infrared cholecysto-cholangiography

Cite this

Liu, Yu Yin ; Kong, Seong Ho ; Diana, Michele ; Lègner, Andras ; Wu, Chun Chi ; Kameyama, Noriaki ; Dallemagne, Bernard ; Marescaux, Jacques. / Near-infrared cholecysto-cholangiography with indocyanine green may secure cholecystectomy in difficult clinical situations : proof of the concept in a porcine model. In: Surgical Endoscopy. 2016 ; Vol. 30, No. 9. pp. 4115-4123.
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abstract = "Background: Biliary injuries remain a major concern in laparoscopic cholecystectomy. New intraoperative guidance modalities, including near-infrared fluorescence cholangiography, are under evaluation. Initial results showed limitations in visualizing the biliary tree in specific clinical situations. The aim of this study was to examine the feasibility and potentiality of fluorescence cholecysto-cholangiography performed with a direct injection of indocyanine green (ICG) in the gallbladder and to compare it to systemic injection in such situations. Materials and methods: Seven pigs were included in this non-survival study. In two pigs, the gallbladder was punctured by a percutaneous needle, and 1 mL of ICG in different concentrations (0.001, 0.01, 0.1, and 1 mg/mL) was sequentially injected. Visibility and pattern of the fluorescent signal around Calot’s triangle were examined and compared with those of two control pigs receiving 2.5 mg of intravenous ICG, 30 min prior to the operation. Different scenarios of cholecystitis were modeled using an injection of a mixture of blood and agarose gel around Calot’s triangle area in the remaining three pigs, and the applicability of direct intragallbladder injection methods was evaluated. Results: The fluorescent signal was identified immediately after intragallbladder injection, and the cystic duct became visible by 0.1 and 1 mg/mL of ICG. The whole cystic duct and the infundibulum of the gallbladder were clearly enhanced by intragallbladder ICG injection, but not by systemic injection. In the cholecystitis models, the cystic duct could be identified only after partial dissection, and fluorescence visualization of the gallbladder infundibulum provided crucial information to find the correct starting point of dissection. Conclusions: Fluorescence cholecysto-cholangiography through direct intragallbladder ICG injection could rapidly provide an adequate visualization of gallbladder neck and cystic duct and might be a valid option to increase the safety of cholecystectomy in case of cholecystitis.",
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Near-infrared cholecysto-cholangiography with indocyanine green may secure cholecystectomy in difficult clinical situations : proof of the concept in a porcine model. / Liu, Yu Yin; Kong, Seong Ho; Diana, Michele; Lègner, Andras; Wu, Chun Chi; Kameyama, Noriaki; Dallemagne, Bernard; Marescaux, Jacques.

In: Surgical Endoscopy, Vol. 30, No. 9, 01.09.2016, p. 4115-4123.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Near-infrared cholecysto-cholangiography with indocyanine green may secure cholecystectomy in difficult clinical situations

T2 - proof of the concept in a porcine model

AU - Liu, Yu Yin

AU - Kong, Seong Ho

AU - Diana, Michele

AU - Lègner, Andras

AU - Wu, Chun Chi

AU - Kameyama, Noriaki

AU - Dallemagne, Bernard

AU - Marescaux, Jacques

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background: Biliary injuries remain a major concern in laparoscopic cholecystectomy. New intraoperative guidance modalities, including near-infrared fluorescence cholangiography, are under evaluation. Initial results showed limitations in visualizing the biliary tree in specific clinical situations. The aim of this study was to examine the feasibility and potentiality of fluorescence cholecysto-cholangiography performed with a direct injection of indocyanine green (ICG) in the gallbladder and to compare it to systemic injection in such situations. Materials and methods: Seven pigs were included in this non-survival study. In two pigs, the gallbladder was punctured by a percutaneous needle, and 1 mL of ICG in different concentrations (0.001, 0.01, 0.1, and 1 mg/mL) was sequentially injected. Visibility and pattern of the fluorescent signal around Calot’s triangle were examined and compared with those of two control pigs receiving 2.5 mg of intravenous ICG, 30 min prior to the operation. Different scenarios of cholecystitis were modeled using an injection of a mixture of blood and agarose gel around Calot’s triangle area in the remaining three pigs, and the applicability of direct intragallbladder injection methods was evaluated. Results: The fluorescent signal was identified immediately after intragallbladder injection, and the cystic duct became visible by 0.1 and 1 mg/mL of ICG. The whole cystic duct and the infundibulum of the gallbladder were clearly enhanced by intragallbladder ICG injection, but not by systemic injection. In the cholecystitis models, the cystic duct could be identified only after partial dissection, and fluorescence visualization of the gallbladder infundibulum provided crucial information to find the correct starting point of dissection. Conclusions: Fluorescence cholecysto-cholangiography through direct intragallbladder ICG injection could rapidly provide an adequate visualization of gallbladder neck and cystic duct and might be a valid option to increase the safety of cholecystectomy in case of cholecystitis.

AB - Background: Biliary injuries remain a major concern in laparoscopic cholecystectomy. New intraoperative guidance modalities, including near-infrared fluorescence cholangiography, are under evaluation. Initial results showed limitations in visualizing the biliary tree in specific clinical situations. The aim of this study was to examine the feasibility and potentiality of fluorescence cholecysto-cholangiography performed with a direct injection of indocyanine green (ICG) in the gallbladder and to compare it to systemic injection in such situations. Materials and methods: Seven pigs were included in this non-survival study. In two pigs, the gallbladder was punctured by a percutaneous needle, and 1 mL of ICG in different concentrations (0.001, 0.01, 0.1, and 1 mg/mL) was sequentially injected. Visibility and pattern of the fluorescent signal around Calot’s triangle were examined and compared with those of two control pigs receiving 2.5 mg of intravenous ICG, 30 min prior to the operation. Different scenarios of cholecystitis were modeled using an injection of a mixture of blood and agarose gel around Calot’s triangle area in the remaining three pigs, and the applicability of direct intragallbladder injection methods was evaluated. Results: The fluorescent signal was identified immediately after intragallbladder injection, and the cystic duct became visible by 0.1 and 1 mg/mL of ICG. The whole cystic duct and the infundibulum of the gallbladder were clearly enhanced by intragallbladder ICG injection, but not by systemic injection. In the cholecystitis models, the cystic duct could be identified only after partial dissection, and fluorescence visualization of the gallbladder infundibulum provided crucial information to find the correct starting point of dissection. Conclusions: Fluorescence cholecysto-cholangiography through direct intragallbladder ICG injection could rapidly provide an adequate visualization of gallbladder neck and cystic duct and might be a valid option to increase the safety of cholecystectomy in case of cholecystitis.

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KW - Indocyanine green (ICG)

KW - Laparoscopic cholecystectomy

KW - Near-infrared cholangiography

KW - Near-infrared cholecysto-cholangiography

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