Near-infrared cholangiography can increase the chance of success in laparoscopic approaches to common bile duct stones, even with previous abdominal surgery

Wei Juo Tzeng, Yu Hung Lin, Teng Yuan Hou, Shih‑Min ‑M Yin, Yu Cheng Lin, Yueh Wei Liu, Yu Yin Liu*, Wei Feng Li, Chih Chi Wang, Jacques Marescaux, Michele Diana

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

Abstract

Background: The treatment of common bile duct (CBD) stones with minimally invasive surgery (MIS) is more technical demanding than laparoscopic cholecystectomy (LC), especially in patients with history of previous abdominal surgery, cholangitis or cholecystitis. Near-infrared (NIR) cholangiography via systemic or biliary tree administration of indocyanine green (ICG), which enhances the visualization of the biliary tree anatomy, may increase the reassurance of CBD localization. The aim of this study was to identify the benefit of near-infrared cholangiography for laparoscopic common bile duct exploration (LCBDE). Methods: Three groups of CBD stone patients were included in this retrospective study depending on the surgical methods: 1) open choledocholithotomy (OCC), 2) laparoscopic choledocholithotomy (LCC), and 3) near-infrared cholangiography-assisted laparoscopic choledocholithotomy (NIR-CC). For the NIR-CC group, either 3 ml (concentration: 2.5 mg/mL) of ICG were intravenously administered or 10 ml (concentration: 0.125 mg/mL) of ICG were injected directly into the biliary tree. The enhancement rate of the cystic duct (CD), CBD, the upper and lower margin of the CBD were compared using white light image. Results: A total of 187 patients with a mean age of 68.3 years were included (OCC, n = 56; LCC, n = 110; NIR-CC, n = 21). The rate of previous abdominal surgery was significantly lower in the LCC group. The conversion rate was similar between the LCC and the NIR CC groups (p = 0.746). The postoperative hospital stay was significantly longer in the OCC group. No differences in morbidity and mortality were found between the three groups. In the NIR-CC group, the localization of CBD was as high as 85% compared to 24% with white light imaging. Conclusions: Near-infrared cholangiography helps increase the chance of success in minimally invasive approaches to CBD stones even in patients with previous abdominal surgeries, without increasing the rate of conversion.

Original languageEnglish
Article number203
Pages (from-to)203
JournalBMC Surgery
Volume23
Issue number1
DOIs
StatePublished - 15 07 2023
Externally publishedYes

Bibliographical note

© 2023. The Author(s).

Keywords

  • Common bile duct stone
  • Fluorescence-guided surgery
  • Indocyanine green
  • Laparoscopic common bile duct stone exploration
  • Near-infrared cholangiography
  • Cholecystectomy, Laparoscopic/methods
  • Gallstones/diagnostic imaging
  • Humans
  • Indocyanine Green
  • Laparoscopy
  • Cholangiography/methods
  • Common Bile Duct/diagnostic imaging
  • Aged
  • Retrospective Studies

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