Page 3 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Role of Indocyanine Green in Laparoscopic Cholecystectomy

2
1
George C Obonna , Martin C Obonna , Rajneesh K Mishra 3
AbstrAct
Background: The most feared complication during laparoscopic cholecystectomy (LC) is bile duct injury. Real-time intraoperative imaging
using indocyanine green (ICG) reduces the risk of bile duct injury by improving visualization of the biliary tree during laparoscopy. This effect
will also shorten operative time and hence reduce the dangers of prolonged operation time. It also subserves the diagnostic value in its use
in the liver function test.
Aim: This study was aimed to elucidate the role of ICG as an investigative tool that aids the operative procedure of laparoscopic cholecystectomy.
Materials and methods: The analysis of case series of ICG laparoscopic cholecystectomy in our hospital—the World Laparoscopic Hospital,
Gurgaon, India.
Results: In all the cases, fluorescent cholangiography using intravenous injection of ICG has become the optimal tool to confirm the biliary tract
anatomy during LC because it has potential advantages over radiographic cholangiography in that it does not require irradiation or dissection
of the triangle of Calot. This early visualization of the cystic duct and additional imaging of the common bile duct (CBD) may increase safety in
LC and offers an alternative to the intraoperative cholangiogram in patients with increased risk of CBD injury.
Conclusion: Laparoscopic cholecystectomy with real-time ICG fluorescence cholangiography enables a better visualization and identification
of the biliary tree and therefore should be considered as a means of increasing the safety of LC.
Keywords: Acute cholecystitis, Indocyanine green cholangiography, Laparoscopic cholecystectomy.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1388

IntroductIon 1 Department of Surgery, University of Medical Sciences Teaching

Laparoscopic cholecystectomy (LC) is the gold standard in the Hospital, UNIMED Ondo, Nigeria
removal of the diseased gallbladder. Bile duct injury is rare with 2 Department of Anatomy, College of Medicine, Abia State University,
1
an incidence of 0.3–0.7%, but it can lead to serious consequences. Uturu, Nigeria
Surgery for gallbladder disease tends to be difficult for even 3 Department of Minimal Access Surgery, World Laparoscopy Hospital,
experienced doctors and has a high risk of complications. Gurugram, Haryana, India; Department Chair, Minimal Access Surgery,
Intraoperative fluorescent imaging with indocyanine green The Global Open University, Nagaland, India
(ICG) has been employed for confirming the potency of vascular Corresponding Author: George C Obonna, Department of Surgery,
2
reconstruction surgery, liver transplantation, anastomosis of the University of Medical Sciences Teaching Hospital, UNIMED Ondo,
3
4
gastrointestinal tract (GIT), brain aneurysms, identification of sentinel Nigeria, Phone: +234 8038584310, e-mail: obogeo2009@yahoo.com
5
6
lymph mode navigation, and hepatocellular carcinoma detection. How to cite this article: Obonna GC, Obonna MC, Mishra RK. Role of
Recently, an intraoperative cholangiography technique in LC involving Indocyanine Green in Laparoscopic Cholecystectomy. World J Lap
the excretion of fluorescent ICG in the bile after intravenous injection Surg 2020;13(1):1–3.
has been used to determine the bile duct anatomy. 7–9 Source of support: Nil

Currently, some detailed reports 10,11 have been published on LC Conflict of interest: None
using intraoperative ICG cholangiography and suggested its safety
and feasibility. In this study, we evaluated the process of intraoperative
ICG cholangiography including LC for gallbladder disease. likelihood of causing an injury to the bile ducts. This is, however,
Indocyanine green is a medical dye that subserves wide unlike the conventional imaging, whose results are usually
application especially in its use in biliary surgery. Its fluorescent not very successful. It has been noted that the intraoperative
properties under near-infrared light have been used in the misidentification of the bile ducts anatomy is usually the main
intraoperative characterization of the biliary tree to ensure safe cause of bile duct injury.
surgery during LC. It is a tricarbocyanine dye having a molecular
weight of 751 Da. dIscussIon
MAterIAls And Methods Indocyanine green is also known as the florescent dye. This dye
has been used since 1956. Aurogreen trade mark is injected
Based on the procedures of ICG, LC was performed at the World
Laparoscopy Hospital, India. intravenously 45 minutes before surgery. It is actually the one that
helps light the path for better and real-time identification of the
results biliary anatomy during LC. There is a florescent imaging system that
is usually used together with a laparoscope. The system must have
Results show that there was positive and successful intraoperative a lightning system that provides light for both infrared and xenon
identification of the extrahepatic bile ducts. This reduced the rays. Figure 1 shows the package of ICG. Figure 2 demonstrated

© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.