Surgery begins with an infra-umbilical incision and peritoneum is instilled via a veress needle. Laparoscopic cholecystectomy in our centre is performed using the three port technique. Ethic approval for this study was waived following consultation with the institutional review board because all patients consented on the use of their data in this study. All procedures were performed as in-hospital procedures in general anesthesia. The preoperative diagnostic was performed as reported elsewhere. The indication for surgery was either symptomatic gallbladder stones or acute cholecystitis. This is an analysis of prospectively data of patients undergoing laparoscopic cholecystectomy for benign gallbladder diseases in a referral centre for visceral, minimally invasive and oncologic surgery. Herein we report our experience with lifetime IGC imaging of the biliary tree in patients undergoing laparoscopic cholecystectomy for benign gallbladder disorders and compared the outcomes of patients undergoing laparoscopic cholecystectomy with and without ICG. The fact that ICG is metabolized in the liver and excreted via bile makes it an excellent medium for biliary tree imaging.

The angiographic feature of ICG is based on its fluorescent character in the near-infrared range between 790 and 805 nm, which can be detected by specialized infrared video cameras. ICG is metabolized by the liver and excreted in bile. ICG is a water soluble tricarbocyanine molecule that is almost completely protein bound following intravenous injection. Intraoperative studies of the biliary tree have been achieved using Indocyanine Green ICG.

Despite these measures, bile duct injury still remains a serious problem. Intraoperative sonographic and radiographic examination of the biliary tree constitute standard methods for studying the biliary anatomy during surgery. The critical view of safety and dissection within the triangle of calot constitute the most commonly employed means of prevention or reducing bile duct injury. Many measures have been implemented to reduce the risk of bile duct injury during laparoscopic cholecystectomy. Although a large portion of bile duct injury consist of minor injuries, extensive and complex injuries to the biliary tree during laparoscopic cholecystectomy might have devastating consequences for the patients involved. Laparoscopic cholecystectomy for acute cholecystitis has been shown to be associated with a much higher risk of bile duct injury with rates as high as 4% being reported in the literature depending on the extent of gallbladder inflammation. The lifetime risk bile duct injury following laparoscopic cholecystectomy for gallbladder stones without acute inflammation in the hands of an experienced surgeon has been reported to be about 0.4%. Bile duct injury with varying severity represents the most feared complication following laparoscopic cholecystectomy. The minimal invasive access, notably laparoscopic route now represents the standard procedure for patients with benign gallbladder disorders. Laparoscopic cholecystectomy with real-time indocyanine green fluorescence cholangiography enables a better visualization and identification of biliary tree and therefore should be considered as a means of increasing the safety of laparoscopic cholecystectomy.Ĭholecystectomy is one of the most commonly performed procedures in general surgery with over a million procedures worldwide each year. These differences were not statistically significant. NO bile duct injury occurred in both groups. The rate of conversion was 2.4% in the group without ICG, while no conversion was performed in the group with ICG. 54.0 min while the median length of stay was 2.0 d in the group with and without ICG respectively.

The median duration of surgery was 53.0 vs. Seventy patients including 29 with and 41 without ICG underwent laparoscopic cholecystectomy within the period of investigation. The outcomes of laparoscopic cholecystectomy with and without ICG were compared using the duration of surgery, the rate of bile duct injury, the rate of conversion, complications and the length of stay. We hypothesized that laparoscopic cholecystectomy with real-time ICG enables a better identification of the biliary tree and thus increases surgical safety. MethodsĪ retrospective analysis of the data of patients undergoing laparoscopic cholecystectomy with and without ICG in a referral centre for minimally invasive surgery was performed. We compared the outcomes of laparoscopic cholecystectomy in patients with and without real-time ICG. Real-time intraoperative imaging using indocyanine green (ICG) might reduce the risk of bile duct injury by improving visualization of the biliary tree during laparoscopic cholecystectomy. Bile duct injury is the most feared complication during laparoscopic cholecystectomy.

Spy agent green kit cost