Accurate recognition of Calot’s triangle during cholecystectomy is important in preventing intraoperative and postoperative complications. The use of indocyanine green (ICG) fluorescence imaging has become increasingly prevalent in cholecystectomy procedures. Our study aimed to evaluate the specific effects of ICG-assisted imaging in reducing complications.
Materials and Methods
A comprehensive search of databases including PubMed, Web of Science, Europe PMC, and WANFANGH DATA was conducted to identify relevant articles up to July 5, 2023. Review Manager 5.3 software was applied to statistical analysis.
Results
Our meta-analysis of 14 studies involving 3576 patients compared the ICG group (1351 patients) to the control group (2225 patients). The ICG group had a lower incidence of postoperative complications (4.78% vs 7.25%; RR .71; 95%CI: .54-.95; P = .02). Bile leakage was significantly reduced in the ICG group (.43% vs 2.02%; RR = .27; 95%CI: .12-.62; I2 = 0; P = .002), and they also had a lower bile duct drainage rate (24.8% vs 31.8% RR = .64, 95% CI: .44-.91, P = .01). Intraoperative complexes showed no statistically significant difference between the 2 groups (1.16% vs 9.24%; RR .17; 95%CI .03-1.02), but the incidence of intraoperative bleeding is lower in the ICG group.
Conclusion
ICG fluorescence imaging-assisted cholecystectomy was associated with a range of benefits, including a lower incidence of postoperative complications, decreased rates of bile leakage, reduced bile duct drainage, fewer intraoperative complications, and reduced intraoperative bleeding.
KhanMHowardTFogelE, et al.Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center. Gastrointest Endosc. 2007;65(2):247-252. doi:10.1016/j.gie.2005.12.037
2.
CassinottiEAl-TaherMAntoniouSA, et al.European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery. Surg Endosc. 2023;37:1629-1648. doi:10.1007/s00464-023-09928-5
SauterGMoussavianAMeyerGSteitzHParhoferKJüngstD. Bowel habits and bile acid malabsorption in the months after cholecystectomy. Am J Gastroenterol. 2002;97(7):1732-1735. doi:10.1111/j.1572-0241.2002.05779.x
5.
BarrettMAsbunHChienHBruntLTelemDA. Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endosc. 2018;32(4):1683-1688. doi:10.1007/s00464-017-5847-8
6.
AhmadDFaulxA. Management of postcholecystectomy biliary complications: a narrative review. Am J Gastroenterol. 2020;115(8):1191-1198. doi:10.14309/ajg.0000000000000704
7.
ChiCDuYYeJ, et al.Intraoperative imaging-guided cancer surgery: from current fluorescence molecular imaging methods to future multi-modality imaging technology. Theranostics. 2014;4(11):1072-1084. doi:10.7150/thno.9899
8.
StrigalevMTzedakisSNassarA, et al.Intra-operative indocyanine green fluorescence imaging in hepatobiliary surgery: a narrative review of the literature as a useful guide for the surgeon. Updates Surg. 2023;75(1):23-29. doi:10.1007/s13304-022-01388-1
9.
KonoYIshizawaTTaniK, et al.Techniques of fluorescence cholangiography during laparoscopic cholecystectomy for better delineation of the bile duct anatomy. 2015;94(25):e1005. doi:10.1097/md.0000000000001005
10.
ZhangZHeKChiCHuZTianJ,. Intraoperative fluorescence molecular imaging accelerates the coming of precision surgery in China. Eur J Nucl Med Mol Imaging. 2022;49(8):2531-2543. doi:10.1007/s00259-022-05730-y
11.
LieHIrawanASudirmanT, et al.Efficacy and safety of near-infrared florescence cholangiography using indocyanine green in laparoscopic cholecystectomy: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2023;33(5):434-446. doi:10.1089/lap.2022.0495
12.
VlekSvan DamDRubinsteinS, et al.Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review. Surg Endosc. 2017;31(7):2731-2742. doi:10.1007/s00464-016-5318-7
13.
van den BosJScholsRBoniL, et al.Near-infrared fluorescence cholangiography assisted laparoscopic cholecystectomy (FALCON): an international multicentre randomized controlled trial. Surg Endosc. 2023;37(6):4574-4584. doi:10.1007/s00464-023-09935-6
14.
LiZZhouYTianG, et al.Meta-analysis on the efficacy of indocyanine green fluorescence angiography for reduction of anastomotic leakage after rectal cancer surgery. Am Surg. 2021;87(12):1910-1919. doi:10.1177/0003134820982848
15.
XuCYinMWangH, et al.Indocyanine green fluorescent cholangiography improves the clinical effects of difficult laparoscopic cholecystectomy. Surg Endosc. 2023;37:5836-5846. doi:10.1007/s00464-023-10035-8
16.
MaCZhangLWenJZhangWChenH. Indocyanine green imaging in laparoscopic cholecystectomy plus laparoscopic common bile duct exploration: a suitable option for patients with difficult exploration (with videos). Exploration (With Videos). 2023;33(3):235-240. doi:10.1097/sle.0000000000001162
17.
IacuzzoCBressanLTroianMGermaniPGiudiciFBortulM. The added value of intraoperative near-infrared fluorescence imaging in elective laparoscopic cholecystectomy. Surg Innov. 2022;29(6):716-722. doi:10.1177/15533506211052744
18.
HuangHDuDWangZ, et al.Application of intraoperative fluorescence imaging with indocyanine green in the difficult gallbladder: a comparative study between indocyanine green-guided fluorescence cholangiography and conventional surgery. Surgery. 2023;33(4):404-410. doi:10.1089/lap.2022.0467
19.
JinHYangJLuLCuiM. Propensity score matching between conventional laparoscopic cholecystectomy and indocyanine green cholangiography-guided laparoscopic cholecystectomy: observational study. Lasers Med Sci. 2022;37(2):1351-1359. doi:10.1007/s10103-021-03401-2
20.
BuchsNPuginFAzaguryD, et al.Real-time near-infrared fluorescent cholangiography could shorten operative time during robotic single-site cholecystectomy. Surg Endosc. 2013;27(10):3897-3901. doi:10.1007/s00464-013-3005-5
21.
BroderickRLeeACheverieJ, et al.Fluorescent cholangiography significantly improves patient outcomes for laparoscopic cholecystectomy. Surg Endosc. 2021;35(10):5729-5739. doi:10.1007/s00464-020-08045-x
22.
SheWCheungTChanM, et al.Routine use of ICG to enhance operative safety in emergency laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc. 2022;36(6):4442-4451. doi:10.1007/s00464-021-08795-2
23.
WangCPengWYangJ, et al.Application of near-infrared fluorescent cholangiography using indocyanine green in laparoscopic cholecystectomy. J Int Med Res. 2020;48(12):300060520979224. doi:10.1177/0300060520979224
24.
CongW.Clinical efficacy of fluorescence-navigated laparoscopic surgery intreatment of cholecystolithiasis after biliary drainage. 2022;31(2):152-159. doi:10.7659/j.issn.1005-6947.2022.02.002
25.
PengZConghuiH. Accurate localization of the triangle of the gallbladder in fluorescent laparoscopic cholecystectomy. Journal of Clinical Surgery. 2021;29(7):631-634. doi:10.3969/j.issn.1005-6483.2021.07.012
26.
ZhangXDLiTJinL, et al.Value of indocyanine green fluorescence tracer in laparoscopic cholecystectomy for acute cholecystitis National Medical Journal of China. Zhonghua Yi Xue Za Zhi. 2022;102(20):1518-1522. doi:10.3760/cma.j.cn112137-20211210-02757
27.
YunfengWDongyunCJieHDaguangT. Application of indocyanine green fluorescent navigation in laparoscopic cholecystectomy for type I Mirizzi syndrome. Chinese Journal of General Surgery. 2022;31(8):1031-1038. doi:10.7659/j.issn.1005-6947.2022.08.006
28.
OrtenziMCorallinoDBotteriE, et al.Safety of laparoscopic cholecystectomy performed by trainee surgeons with different cholangiographic techniques (SCOTCH): a prospective non-randomized trial on the impact of fluorescent cholangiography during laparoscopic cholecystectomy performed by trainees. Surg Endosc. 2024;38(2):1045-1058. doi:10.1007/s00464-023-10613-w
29.
FujitaNYasudaIEndoI, et al.Evidence-based clinical practice guidelines for cholelithiasis 2021. J Gastroenterol. 2023;58(9):801-833. doi:10.1007/s00535-023-02014-6
30.
ZhuSHuangJLiY, et al.Systematic appraisal of guidelines for the diagnosis and treatment of choledocholithiasis. Surg Laparosc Endosc Percutan Tech. 2023;33(6):673-681. doi:10.1097/sle.0000000000001230
31.
SinhaAMattsonANjereISinhaC. Comparison of laparoscopic cholecystectomy in children at paediatric centres and adult centres: a systematic review and meta-analysis. Ann R Coll Surg Engl2024;1-9. doi:10.1308/rcsann.2023.0041
32.
ManudhaneALeupoldMShahH, et al.A review on endoscopic management of acute cholecystitis: endoscopic ultrasound-guided gallbladder drainage and endoscopic transpapillary gallbladder drainage. Medicina. 2024;60:212. doi:10.3390/medicina60020212
33.
LiuYLiaoCDianaM, et al.Near-infrared cholecystocholangiography with direct intragallbladder indocyanine green injection: preliminary clinical results. Surg Endosc. 2018;32(3):1506-1514. doi:10.1007/s00464-017-5838-9
34.
RoyMDipFNguyenD, et al.Fluorescent incisionless cholangiography as a teaching tool for identification of Calot’s triangle. Surg Endosc. 2017;31(6):2483-2490. doi:10.1007/s00464-016-5250-x
35.
LehrskovLWestenMLarsenSJensenAKristensenBBisgaardT. Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial. Br J Surg. 2020;107(6):655-661. doi:10.1002/bjs.11510
36.
AgnusVPesceABoniL, et al.Fluorescence-based cholangiography: preliminary results from the IHU-IRCAD-EAES EURO-FIGS registry. Surg Endosc. 2020;34(9):3888-3896. doi:10.1007/s00464-019-07157-3
37.
PeriniDMartellucciJ. Don’t forget emergency surgery! Lessons to learn from elective indocyanine green-guided gastrointestinal interventions. World J Gastrointest Surg. 2024;16(2):270-275. doi:10.4240/wjgs.v16.i2.270
38.
OldhaferKReeseTFard-AghaieM, et al.[Intraoperative fluorescence angiography and cholangiography with indocyanine green in hepatobiliary surgery]. Chirurg. 2019;90(11):880-886. doi:10.1007/s00104-019-01035-3
39.
Castagneto-GisseyLRussoMIodiceA, et al.Intracholecystic versus intravenous indocyanine green (ICG) injection for biliary anatomy evaluation by fluorescent cholangiography during laparoscopic cholecystectomy: a case-control study. J Clin Med. 2022;11(12):3508. doi:10.3390/jcm11123508
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