In cholecystitis, the border between gallbladder and common bile duct is important as well as CBD and cystic duct. We hypothesized injection of ICG into gallbladder directly will be helpful to identify cystic duct, CBD and the border of gallbladder as well as systemic injection. The purpose of this study was to evaluate feasibility of this image guide surgery Study Design: We will collect the pre-operative medical history and arrange physical examination, life quality evaluation, blood and biochemical test. The Patients with acute cholecystitis, gallstone or gallbladder polyp without interventional treatment or cholecystitis after percutaneous gallbladder drainage (PTGBD) were involved in this study.
Four laparoscopic ports were introduced and the pneumoperitoneum (12mmHg) was established. In study group, ICG was given by intra-gallbladder injection or systemic injection, the cholecystectomy was performed. In control group, no ICG was given and traditional cholecystectomy were performed. A near-infrared optimized laparoscope was used to detect the ICG fluorescence signal arising from gallbladder, cystic duct and common bile duct before cholecystectomy in study group. According to the enhancement of ICG, the cholecystectomy was started from cystic duct in Calot’s triangle. Time to gallbladder removed was recorded. Conversion rate, post-operative morbidity and mortality will be recorded as well. Expected results: A. Publish Intra-gallbladder indocyanide green injection via drainage route facilitate cholecystectomy in acute cholecystitis B. Publish Comparison of systemic and intra-gallbladder injection of indocyanide green in benefit for cholecystectomy C. Extend to publish Near-infrared cholangiography decreased learning curve of laparoscopic cholecystectomy for medical student D. Near- infrared laparoscope education textbook and clinical case analysis
Cholecystectomy is a surgical procedure that involves the removal of the gallbladder, typically due to the presence of gallstones or other gallbladder diseases. While the procedure is generally safe and effective, there are certain challenges associated with cholecystectomy, particularly in cases where the anatomy of the gallbladder is not well-defined. Intra-gallbladder or systemic indocyanine green injection is a technique that has been developed to facilitate cholecystectomy by providing improved visualization of the gallbladder anatomy during the procedure.
Intra-gallbladder or systemic indocyanine green injection involves the use of a fluorescent dye called indocyanine green (ICG). The dye is injected into the gallbladder, either directly or systemically, and then activated using near-infrared light. The ICG dye produces a bright green fluorescence that can be visualized using special cameras, providing surgeons with a real-time view of the gallbladder and surrounding structures during the procedure.
The use of ICG dye in cholecystectomy has several potential benefits. One of the main benefits is that it can help improve visualization of the gallbladder anatomy, particularly in cases where the anatomy is difficult to define. The bright green fluorescence produced by the ICG dye can help distinguish the gallbladder from surrounding tissues and structures, making it easier for surgeons to identify and remove the gallbladder.
Additionally, the use of ICG dye can help reduce the risk of injury to surrounding structures during the procedure. By providing improved visualization, surgeons can avoid accidentally injuring important structures such as the common bile duct or hepatic artery.
Intra-gallbladder or systemic indocyanine green injection is a relatively new technique, and research on its effectiveness is still ongoing. However, early studies have shown promising results. A study published in the Journal of Laparoendoscopic & Advanced Surgical Techniques in 2017 found that the use of ICG dye in cholecystectomy improved visualization of the gallbladder and reduced the risk of bile duct injury.
Another study published in the Journal of Gastrointestinal Surgery in 2020 found that the use of ICG dye in cholecystectomy was associated with a shorter operative time and a lower rate of bile duct injury compared to traditional cholecystectomy techniques.
While the use of ICG dye in cholecystectomy shows promise, there are also some potential limitations and drawbacks to consider. One potential limitation is that the use of ICG dye may add additional time and cost to the procedure, particularly in cases where specialized equipment is required to activate the dye. Additionally, some patients may have allergic reactions to the dye or experience other side effects.
Another potential limitation is that the use of ICG dye in cholecystectomy is still a relatively new technique, and more research is needed to fully understand its long-term effectiveness and safety. It is important for surgeons to carefully consider the risks and benefits of using ICG dye in each individual case and to ensure that appropriate patient selection and monitoring is in place.
One potential application of intra-gallbladder or systemic indocyanine green injection is in cases where the anatomy of the gallbladder is not well-defined or is obscured by surrounding structures. This can occur in patients with obesity or other conditions that make it difficult to visualize the gallbladder during surgery. By providing improved visualization, the use of ICG dye can help reduce the risk of injury to surrounding structures and improve the overall safety and effectiveness of the procedure.
Another potential application of ICG dye in cholecystectomy is in cases where the patient has had previous abdominal surgery or other abdominal abnormalities. These factors can make it more difficult to visualize the gallbladder during surgery and can increase the risk of complications such as bile duct injury. The use of ICG dye can help improve visualization in these cases and reduce the risk of complications.
Furthermore, the use of ICG dye in cholecystectomy may be particularly beneficial in laparoscopic or robotic-assisted procedures. In these procedures, the surgeon is working with a limited field of view and may have less tactile feedback than in traditional open surgery. The use of ICG dye can help improve visualization and provide the surgeon with more information about the location and anatomy of the gallbladder, potentially improving the safety and effectiveness of the procedure.
It is important to note that the use of ICG dye in cholecystectomy is not without potential risks and limitations. While the technique has been shown to be safe and effective in early studies, more research is needed to fully understand its long-term safety and effectiveness. Additionally, some patients may have allergic reactions or other adverse effects to the dye.
Moreover, the use of ICG dye may add additional time and cost to the procedure, particularly in cases where specialized equipment is required to activate the dye. Surgeons should carefully weigh the potential risks and benefits of using ICG dye in each individual case and ensure that appropriate patient selection and monitoring is in place.
In conclusion, intra-gallbladder or systemic indocyanine green injection is a promising technique that can facilitate cholecystectomy by providing improved visualization of the gallbladder anatomy. The technique has been shown to reduce the risk of bile duct injury and may lead to shorter operative times compared to traditional cholecystectomy techniques. However, more research is needed to fully understand the long-term effectiveness and safety of the technique. Surgeons should carefully consider the risks and benefits of using ICG dye in each individual case and ensure that appropriate patient selection and monitoring is in place. With proper patient selection and monitoring, the use of ICG dye in cholecystectomy has the potential to improve outcomes for patients undergoing the procedure.
