Ricerc@Sapienza

Background The aim is to evaluate safety and efficacy of near infra-red (NIR) indocyanine green (ICG) fluorescence structural
imaging during laparoscopic cholecystectomy (LC) (Group A) and to compare perioperative data, including operative
time, with a series of patients who underwent LC with routine traditional intraoperative cholangiography (IOC) (Group B).
Methods Forty-four patients with acute or chronic cholecystitis underwent NIR-ICG fluorescent cholangiography during LC.
ICG was administered intravenously at different time intervals or by direct gallbladder injection during surgery. Fluorescence
intensity and anatomy identification were scored according to a visual analogue scale between 1 (least accurate) and 5 (most
accurate). Group B patients (n = 44) were chosen from a prospectively maintained database of patients who underwent LC
with routine IOC, matched for age, sex, body mass index, and diagnosis with group A patients.
Results No adverse reactions were recorded. In group A, mean time between intravenous administration of ICG and surgery
was 10.7 ± 8.2 (range 2–52) h. Administered doses ranged from 3.5 to 13.5 mg. Fluorescence was present in all cases, scoring
≥ 3 in 41 patients. Mean operative time was 86.9 ± 36.9 (30–180) min in group A and 117.9 ± 43.4 (40–220) min in group
B (p = 0.0006). No conversion to open surgery nor bile duct injuries were observed in either group.
Conclusions LC with NIR-ICG fluorescent cholangiography is safe and effective for early recognition of anatomical landmarks,
reducing operative time as compared to LC with IOC, even when residents were the main operator. NIR-ICG fluorescent
cholangiography was effective in patients with acute cholecystitis and in the obese. Data collection into large registries
on the results of NIR-ICG fluorescent cholangiography during LC should be encouraged to establish whether this technique
might set a new safety standard for LC.