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.
Ishizawa T, Bandai Y, Ijichi M, et al. Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy. Dr J Surg 2010;97(9):1369–1377. DOI: 10.1002/bjs.7125.
Kubota K, Kita J, Shimoda M, et al. Intraoperative assessment of reconstructed vessels in living-donor liver transplantation, using a novel fluorescence imaging technique. J Hepatobilliary Pancreat Surg 2006;13(2):100–104. DOI: 10.1007/s00534-005-1014-z.
Saito T, Yano M, Motoori M, et al. Subtotal gastrectomy for gastric tube cancer after esophagectomy; safe procedure preserving the proximal part of gastric tube based on intraoperative ICG blood flow evaluation. J Surgoncol 2012;106(1):107–110. DOI: 10.1002/jso.23050.
Raabe A, Beck J, Gerlach R, et al. Near infrared indocyanine green video angiography; a new method for intraoperative assessment of vascular flow. Neurosurgery 2003;52(1):132–139. DOI: 10.1227/00006123-200301000-00017.
Ohdaira H, Nimura H, Mitsumori N, et al. Validity of modified gastrectomy combined with sentinel node navigation surgery for early gastric cancer. Gastric Cancer 2007;10(2):117–122. DOI: 10.1007/s10120-007-0419-6.
Gotoh K, Yamada T, Ishikawa O, et al. A novel image guided surgery of hepatocellular carcinoma by indocyanine green fluorescence imaging navigation. J Surgoncol 2009;100(1):75–79. DOI: 10.1002/jso.21272.
Mitsuhashi N, Kimura F, Shimizu H, et al. Usefulness of intraoperative fluorescence imaging to evaluate local anatomy in hepatobiliary surgery. J Hepatobiliary Pancreat Surg 2008;15(5):508–514. DOI: 10.1007/s00534-007-1307-5.
Tagaya N, Shimoda M, Kato M, et al. Intraoperative exploration of biliary anatomy using fluorescence imaging of indocyanine green in experimental and clinical cholecystectomies. J Hepatobiliary Pancreat Sci 2010;17(5):595–600. DOI: 10.1007/s00534-009-0195-2.
Aoki T, Murakami M, Yasuda D, et al. Intraoperative fluorescent imaging using indocyanine green for liver mapping and cholangiography. J Hepatobiliary PancreatSci 2010;17(5):590–594. DOI: 10.1007/s00534-009-0197-0.
Schools RM, Connell NJ. Stassen near infrared fluorescence imaging for real time intraoperative anatomical guidance in minimally invasive surgery: a systematic review of the literature. World J Surg 2015;39(5):1069–1079. DOI: 10.1007/s00268-014-2911-6.
Vlek SL, Van Dam DA, Rubinstein SM, et al. Biliary tract visualization using near infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review. Surg Endosc 2017(7):2731–2742. DOI: 10.1007/s00464-016-5318-7.