Application of indocyanine green fluorescence imaging in laparoscopic reoperation of the biliary tract
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Department of Hepatopancreatobiliary Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China

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R657.4

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    Abstract:

    Background and Aims Compared to intraoperative cholangiography, the indocyanine green (ICG) fluorescence imaging technique offers the advantages of convenient operation and more precise visualization of intraoperative bile ducts. Foreign studies have confirmed the feasibility and safety of the ICG fluorescence imaging technique. However, there are few reports on applying the ICG fluorescence imaging technique in our country's laparoscopic reoperation of the biliary tract. Therefore, this article reports the authors' preliminary experience in applying the ICG fluorescence imaging technique in laparoscopic reoperation of the biliary tract to assess its clinical value.Methods The clinical data of patients who underwent elective reoperation of the biliary tract in the Second Affiliated Hospital of Kunming Medical University from January 2020 to June 2022 were retrospectively collected according to inclusion and exclusion criteria. Patients who underwent the ICG fluorescence imaging technique during surgery were assigned to the observation group, while those who did not receive this technique were assigned to the control group. Patients in the observation group received a 2 mL (total dose 5 mg) intravenous injection of ICG solution 60 min before the start of surgery, and intraoperative three-dimensional imaging of the bile ducts was performed using near-infrared light.Results A total of 184 patients were included, with 80 in the observation group and 104 in the control group. The success rate of the observed bile duct ICG fluorescence imaging system was 93.75% (75/80). The average bile duct identification time during surgery was significantly shorter in the observation group than in the control group (25 min vs. 39 min, P<0.05). In contrast, other intraoperative variables (surgical approach, operative time, intraoperative blood loss, rate of conversion to open surgery) showed no statistically significant differences between the two groups (all P>0.05). The two groups had no significant differences regarding postoperative ventilation time, bile leakage rate, Clavien-Dindo grade of postoperative complications, and stone recurrence rate at 6 months postoperatively (all P>0.05). However, the observation group had a significantly shorter average hospital stay length than the control group (7.13 d vs. 10.35 d, P=0.032).Conclusion The ICG fluorescence imaging technique in laparoscopic reoperation of the biliary tract enables visualization of the biliary system, which can help avoid inadvertent damage due to poor identification of the bile ducts during surgery. This technique ensures safety in reoperative biliary surgery and holds promising potential for clinical application.

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HUANG Jie, XU Dingwei, LI Xincheng, LI Ao, ZHANG Yan, HU Manqin. Application of indocyanine green fluorescence imaging in laparoscopic reoperation of the biliary tract[J]. Chin J Gen Surg,2023,32(8):1229-1236.
DOI:10.7659/j. issn.1005-6947.2023.08.011

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History
  • Received:April 04,2023
  • Revised:August 03,2023
  • Adopted:
  • Online: November 03,2023
  • Published: