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Title:
Routine use of ICG to enhance operative safety in emergency laparoscopic cholecystectomy: a randomized controlled trial | Surgical Endoscopy
Description:
Objective To test the hypothesis that ICG fluorescence cholangiography (ICG-FC) helps to identify critical structures during laparoscopic cholecystectomy (LC) and hence reduce biliary injuries and conversions. Summary background data In LC, biliary injury and conversion often happen if the biliary anatomy is misidentified. Methods This was a single-center randomized controlled trial from 2017 to 2019. Patients with acute cholecystitis requiring LC were assessed for eligibility for the trial. Patients in the trial were randomized to undergo either conventional LC (conventional arm) or LC with ICG-FC (ICG arm). Conversion rate and biliary injury incidence were outcome measures. Results Totally 92 patients participated (46 patients in each arm). The median age was 61 years in both arms (p = 0.472). The conventional arm had 22 men and 24 women; the ICG arm had 24 men and 22 women (p = 0.677). The two arms were comparable in all perioperative parameters. The time from ICG injection to surgery was 67 (16–1150) min. Both arms had an 8.7% conversion rate (p = 1.000). The median operative time was 140.5 min in the conventional arm and 149.5 min in the ICG arm (p = 0.086). The complication rate was 15.2% in the former and 10.9% in the latter (p = 0.536), and both had a 2.2% bile leakage rate. The median hospital stay was 3.5d in the former and 4.0d in the latter (p = 0.380). Conclusion ICG-FC did not make any difference in conversion or complication rate. Its routine use in LC is questionable. However, it may be helpful in difficult cholecystectomies and may be used as an adjunct. Trial registration The trial was registered with the Institutional Review Board of University of Hong Kong/Hospital Authority Hong Kong West Cluster ( http://www.med.hku.hk/en/research/ethics-and-integrity/human-ethics ). Registration number: UW17-492.
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Keywords {🔍}
pubmed, article, google, scholar, cholecystectomy, laparoscopic, surg, cholangiography, acute, cholecystitis, central, conversion, endosc, icg, biliary, bile, study, cas, trial, injury, patients, fluorescent, intraoperative, open, fluorescence, indocyanine, green, duct, chan, arm, hepatobiliary, sci, risk, analysis, routine, operative, randomized, wing, rate, surgery, strasberg, pancreat, privacy, cookies, content, data, tan, cheung, factors, information,
Topics {✒️}
population-based case-control study month download article/chapter chan & chung mau lo hk/en/research/ethics bile duct injury chung mau lo improve intra-operative visualization population-based cohort study reduce biliary injuries acute cholangitis biliary injury incidence advanced laparoscopic training single-incision laparoscopic cholecystectomy bile acid malabsorption full article pdf acute biliary diseases give indocyanine green infrared fluorescence cholangiography privacy choices/manage cookies population-based study median hospital stay icg fluorescence cholangiography laparoscopic fluorescence cholangiography intraoperative fluorescent cholangiography icg-guided fluorescence tg13 surgical management emergency laparoscopic cholecystectomy fluorescent cholangiography illuminating retrospective cohort study biliary injury related subjects hong kong selective intraoperative cholangiography intended intraoperative cholangiography intraoperative fluorescent imaging integrity/human-ethics open conversion reported case-matched comparison routine intraoperative cholangiography long-term outcomes randomized controlled trial miu yee chan indocyanine green european economic area ka wan chu ka wing ma wing chiu dai biliary anatomy biliary tree van laarhoven cj
Questions {❓}
- Gangemi A, Danilkowicz R, Elli FE et al (2017) Could ICG-aided robotic cholecystectomy reduce the rate of open conversion reported with laparoscopic approach?
- Terho P, Sallinen V, Leppaniemi A et al (2020) Does the surgeon’s caseload affect the outcome in laparoscopic cholecystectomy for acute cholecystitis?
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headline:Routine use of ICG to enhance operative safety in emergency laparoscopic cholecystectomy: a randomized controlled trial
description:To test the hypothesis that ICG fluorescence cholangiography (ICG-FC) helps to identify critical structures during laparoscopic cholecystectomy (LC) and hence reduce biliary injuries and conversions. In LC, biliary injury and conversion often happen if the biliary anatomy is misidentified. This was a single-center randomized controlled trial from 2017 to 2019. Patients with acute cholecystitis requiring LC were assessed for eligibility for the trial. Patients in the trial were randomized to undergo either conventional LC (conventional arm) or LC with ICG-FC (ICG arm). Conversion rate and biliary injury incidence were outcome measures. Totally 92 patients participated (46 patients in each arm). The median age was 61 years in both arms (p = 0.472). The conventional arm had 22 men and 24 women; the ICG arm had 24 men and 22 women (p = 0.677). The two arms were comparable in all perioperative parameters. The time from ICG injection to surgery was 67 (16–1150) min. Both arms had an 8.7% conversion rate (p = 1.000). The median operative time was 140.5 min in the conventional arm and 149.5 min in the ICG arm (p = 0.086). The complication rate was 15.2% in the former and 10.9% in the latter (p = 0.536), and both had a 2.2% bile leakage rate. The median hospital stay was 3.5d in the former and 4.0d in the latter (p = 0.380). ICG-FC did not make any difference in conversion or complication rate. Its routine use in LC is questionable. However, it may be helpful in difficult cholecystectomies and may be used as an adjunct. The trial was registered with the Institutional Review Board of University of Hong Kong/Hospital Authority Hong Kong West Cluster (
http://www.med.hku.hk/en/research/ethics-and-integrity/human-ethics
). Registration number: UW17-492.
datePublished:2022-02-22T00:00:00Z
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Emergency laparoscopic cholecystectomy
Open conversion
Indocyanine green
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Surgery
Gynecology
Gastroenterology
Hepatology
Proctology
Abdominal Surgery
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description:To test the hypothesis that ICG fluorescence cholangiography (ICG-FC) helps to identify critical structures during laparoscopic cholecystectomy (LC) and hence reduce biliary injuries and conversions. In LC, biliary injury and conversion often happen if the biliary anatomy is misidentified. This was a single-center randomized controlled trial from 2017 to 2019. Patients with acute cholecystitis requiring LC were assessed for eligibility for the trial. Patients in the trial were randomized to undergo either conventional LC (conventional arm) or LC with ICG-FC (ICG arm). Conversion rate and biliary injury incidence were outcome measures. Totally 92 patients participated (46 patients in each arm). The median age was 61 years in both arms (p = 0.472). The conventional arm had 22 men and 24 women; the ICG arm had 24 men and 22 women (p = 0.677). The two arms were comparable in all perioperative parameters. The time from ICG injection to surgery was 67 (16–1150) min. Both arms had an 8.7% conversion rate (p = 1.000). The median operative time was 140.5 min in the conventional arm and 149.5 min in the ICG arm (p = 0.086). The complication rate was 15.2% in the former and 10.9% in the latter (p = 0.536), and both had a 2.2% bile leakage rate. The median hospital stay was 3.5d in the former and 4.0d in the latter (p = 0.380). ICG-FC did not make any difference in conversion or complication rate. Its routine use in LC is questionable. However, it may be helpful in difficult cholecystectomies and may be used as an adjunct. The trial was registered with the Institutional Review Board of University of Hong Kong/Hospital Authority Hong Kong West Cluster (
http://www.med.hku.hk/en/research/ethics-and-integrity/human-ethics
). Registration number: UW17-492.
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Emergency laparoscopic cholecystectomy
Open conversion
Indocyanine green
ICG fluorescence
Surgery
Gynecology
Gastroenterology
Hepatology
Proctology
Abdominal Surgery
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