Name: The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation (Video) | JoVE Journal
Uploaded: 2025-01-31T13:50:00.000+00:00
Duration: 3 min 27 s
Description: Learn fluorescence-guided laparoscopic cholecystectomy using indocyanine green injection and DPMI imaging. This technique enhances bile duct visualization and reduces surgical complications in complex procedures.

ai_agent_IP

ai_agent

maintenance

instantTrialDurationMinutes

isBiopharma

enableNewMyJoveSectionDesign

educationFeatures

seoMetaApi

ai_copilot_institution_blacklist

ai_chat_institution_blacklist

freeAccessWindow

ssoRoleCapture

scheduledMaintenanceBanner

joveLabsFeatures

disable_autoplay_for_bots

extended_trial_duration

5 minutes

This work was supported by the National Natural Science Foundation of China (grant number 82272105), Guangdong Basic and Applied Basic Research Foundation (grant number 2022A1515011244, 2023A1515011521, 2023A1515010475), Medical Scientific Research Foundation of Guangdong Province of China (A2017421, 2016116212141586).

This research was conducted in compliance with the guidelines of the human research ethics committee of the Fifth Affiliated Hospital of Sun Yat-sen University. Written informed consent was obtained from the patient for participation in this study. The criteria for complex laparoscopic cholecystectomy (LC) included: gallbladder wall edema with thickening &#8805;4 mm; gangrenous cholecystitis with or without perforation; a history of upper abdominal surgery; impacted stones in the gallbladder neck; Mirizzi syndrome or variations in the extrahepatic bile duct; and cases requiring transcystic common bile duct exploration. Details of the reagents and equipment used are provided in the Table of Materials.
1. Fluorescence imaging preparation and patient positioning
<ol>
	<li>Administer 0.25 mg of ICG via a peripheral vein injection 45 min before the surgery. 
	NOTE: Dissolve 1 vial of ICG (25 mg) in 10 mL of normal saline. Inject 1 mL of the solution into 100 mL of normal saline for dilution. Administer 10 mL of the diluted solution via intravenous injection 45 min before the surgery.</li>
	<li>Set up the DPM-I fluorescence system, a dual-channel image-guided device, to operate in white-light (380-665 nm) and near-infrared (810-1200 nm) spectrums.</li>
	<li>Position the patient in a supine position. After inducing general anesthesia (following institutionally approved protocols) and completing all safety procedures (hood, sterile gloves, and sterile scrub), create a sterile field. Perform trocar insertion using a four-port method15.</li>
</ol>
2. Fluorescence-guided visualization and identification of biliary structures
<ol>
	<li>Switch to fluorescence mode to locate the bile ducts. 
	NOTE: In fluorescence mode, the stained bile duct structure may be directly visible or revealed after simple separation of encysted fat tissue (Figure 1A).</li>
	<li>Follow the fluorescence navigation to carefully dissect and isolate the cystic duct (CD) and cystic artery (CA) using a cautery hook to achieve the critical view of safety, also known as Calot&#39;s Triangle. 
	NOTE: In fluorescence mode, the CD exhibits a fluorescent signal, while the CA does not show any fluorescent signal.</li>
	<li>Apply Hem-O-lock clips to both the CD and CA after identifying and distinguishing the bile ducts. Place two clips proximally and one distally on the CD. Place one clip proximally and one clip distally on the CA. 
	NOTE: Identify the CD-common bile duct (CBD) junction carefully to prevent inadvertent injury to the CBD.</li>
</ol>
3. Removal of gallbladder
<ol>
	<li>Dissect the gallbladder from its fossa, divide the cystic duct (CD) and cystic artery (CA) between the clips using scissors, and place the gallbladder in an extraction bag.</li>
	<li>Employ white-light mode to detect any bleeding and switch to fluorescence mode to confirm the absence of bile leakage upon completion of the cholecystectomy.</li>
	<li>Remove the gallbladder from the abdominal cavity, place a drainage tube at the gallbladder fossa, and close the abdomen using 4-0 polyglactin. Suture the skin with a 3-0 non-absorbable suture. 
	NOTE: Cut the CD only after confirming there is a single duct entering the gallbladder, especially in cases of biliary anatomy variations such as a right accessory hepatic duct.</li>
</ol>
4. Postoperative monitoring and management
<ol>
	<li>Review inflammatory markers postoperatively.</li>
	<li>Remove the abdominal drainage tube when the drainage is clear and less than 50 mL per day.</li>
	<li>Administer prophylactic antibiotics as needed based on the patient&#39;s clinical status and surgeon&#39;s recommendation.</li>
	<li>Monitor the patient for signs of infection, including fever, redness, or swelling at the surgical site.</li>
	<li>Schedule a follow-up consultation within 7-10 days to assess recovery.</li>
</ol>

<ol><li>Lammert, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Gallstones%5BTitle%5D)+AND+%22Nat+Rev+Dis+Primers%22%5BJournal%5D)">Gallstones.</a> Nat Rev Dis Primers. 2, 16024(2016).</li>
<li>Georgiades, C. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Is+inflammation+a+significant+predictor+of+bile+duct+injury+during+laparoscopic+cholecystectomy%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy.</a> Surg Endosc. 22 (9), 1959-1964 (2008).</li>
<li>Flum, D. R., Cheadle, A., Prela, C., Dellinger, E. P., Chan, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Bile+duct+injury+during+cholecystectomy+and+survival+in+medicare+beneficiaries%5BTitle%5D)+AND+%22JAMA%22%5BJournal%5D)">Bile duct injury during cholecystectomy and survival in medicare beneficiaries.</a> JAMA. 290 (16), 2168-2173 (2003).</li>
<li>Ortenzi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Safety+of+laparoscopic+cholecystectomy+performed+by+trainee+surgeons+with+different+cholangiographic+techniques+%28SCOTCH%29%3A+A+prospective+non-randomized+trial+on+the+impact+of+fluorescent+cholangiography+during+laparoscopic+cholecystectomy+performed+by+trainees%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">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.</a> Surg Endosc. 38 (2), 1045-1058 (2024).</li>
<li>Araki, K., Conrad, C., Ogiso, S., Kuwano, H., Gayet, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Intraoperative+ultrasonography+of+laparoscopic+hepatectomy%3A+Key+technique+for+safe+liver+transection%5BTitle%5D)+AND+%22J+Am+Coll+Surg%22%5BJournal%5D)">Intraoperative ultrasonography of laparoscopic hepatectomy: Key technique for safe liver transection.</a> J Am Coll Surg. 218 (2), e37-e41 (2014).</li>
<li>Nguyen, Q. T., Tsien, R. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Fluorescence-guided+surgery+with+live+molecular+navigation-A+new+cutting+edge%5BTitle%5D)+AND+%22Nat+Rev+Cancer%22%5BJournal%5D)">Fluorescence-guided surgery with live molecular navigation-A new cutting edge.</a> Nat Rev Cancer. 13 (9), 653-662 (2013).</li>
<li>Manasseh, M., Davis, H., Bowling, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evaluating+the+Role+of+Indocyanine+Green+Fluorescence+Imaging+in+Enhancing+Safety+and+Efficacy+During+Laparoscopic+Cholecystectomy%3A+A+Systematic+Review%5BTitle%5D)+AND+%22Cureus%22%5BJournal%5D)">Evaluating the Role of Indocyanine Green Fluorescence Imaging in Enhancing Safety and Efficacy During Laparoscopic Cholecystectomy: A Systematic Review.</a> Cureus. 16 (11), e73388(2024).</li>
<li>Zhou, H., He, Y., Chang, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Comparative+study+of+Indocyanine+Green+fluorescence+imaging+versus+conventional+fiber-optic+imaging+in+laparoscopic+choledochotomy+for+stone+extraction+and+immediate+biliary+incision+suturing%5BTitle%5D)+AND+%22Updates+Surg%22%5BJournal%5D)">Comparative study of Indocyanine Green fluorescence imaging versus conventional fiber-optic imaging in laparoscopic choledochotomy for stone extraction and immediate biliary incision suturing.</a> Updates Surg. 76 (6), 2247-2254 (2024).</li>
<li>Quaresima, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Routine+near+infra-red+indocyanine+green+fluorescent+cholangiography+versus+intraoperative+cholangiography+during+laparoscopic+cholecystectomy%3A+A+case-matched+comparison%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Routine near infra-red indocyanine green fluorescent cholangiography versus intraoperative cholangiography during laparoscopic cholecystectomy: A case-matched comparison.</a> Surg Endosc. 34 (5), 1959-1967 (2020).</li>
<li>Lim, S. H., Tan, H. T. A., Shelat, V. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Comparison+of+indocyanine+green+dye+fluorescent+cholangiography+with+intra-operative+cholangiography+in+laparoscopic+cholecystectomy%3A+a+meta-analysis%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Comparison of indocyanine green dye fluorescent cholangiography with intra-operative cholangiography in laparoscopic cholecystectomy: a meta-analysis.</a> Surg Endosc. 35 (4), 1511-1520 (2021).</li>
<li>Benya, R., Quintana, J., Brundage, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Adverse+reactions+to+indocyanine+green%3A+a+case+report+and+a+review+of+the+literature%5BTitle%5D)+AND+%22Cathet+Cardiovasc+Diagn%22%5BJournal%5D)">Adverse reactions to indocyanine green: a case report and a review of the literature.</a> Cathet Cardiovasc Diagn. 17 (4), 231-233 (1989).</li>
<li>Pardo Aranda, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Indocyanine+green+%28ICG%29+fluorescent+cholangiography+in+laparoscopic+cholecystectomy%3A+Simplifying+time+and+dose%5BTitle%5D)+AND+%22Dig+Liver+Dis%22%5BJournal%5D)">Indocyanine green (ICG) fluorescent cholangiography in laparoscopic cholecystectomy: Simplifying time and dose.</a> Dig Liver Dis. 55 (2), 249-253 (2023).</li>
<li>Dip, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Use+of+fluorescence+imaging+and+indocyanine+green+during+laparoscopic+cholecystectomy%3A+Results+of+an+international+Delphi+survey%5BTitle%5D)+AND+%22Surgery%22%5BJournal%5D)">Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: Results of an international Delphi survey.</a> Surgery. 172 (6S), S21-S28 (2022).</li>
<li>Chen, Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Extrahepatic+biliary+tract+visualization+using+near-infrared+fluorescence+imaging+with+indocyanine+green%3A+Optimization+of+dose+and+dosing+time%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Extrahepatic biliary tract visualization using near-infrared fluorescence imaging with indocyanine green: Optimization of dose and dosing time.</a> Surg Endosc. 35 (10), 5573-5582 (2021).</li>
<li>Hori, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Protocol+for+laparoscopic+cholecystectomy%3A+Is+it+rocket+science%5BTitle%5D)+AND+%22World+J+Gastroenterol%22%5BJournal%5D)">Protocol for laparoscopic cholecystectomy: Is it rocket science.</a> World J Gastroenterol. 22 (47), 10287-10303 (2016).</li>
<li>Elshaer, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Subtotal+cholecystectomy+for+%26%2334%3Bdifficult+gallbladders%26%2334%3B%3A+Systematic+review+and+meta-analysis%5BTitle%5D)+AND+%22JAMA+Surg%22%5BJournal%5D)">Subtotal cholecystectomy for &#34;difficult gallbladders&#34;: Systematic review and meta-analysis.</a> JAMA Surg. 150 (2), 159-168 (2015).</li>
<li>Fletcher, D. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Complications+of+cholecystectomy%3A+Risks+of+the+laparoscopic+approach+and+protective+effects+of+operative+cholangiography%3A+A+population-based+study%5BTitle%5D)+AND+%22Ann+Surg%22%5BJournal%5D)">Complications of cholecystectomy: Risks of the laparoscopic approach and protective effects of operative cholangiography: A population-based study.</a> Ann Surg. 229 (4), 449-457 (1999).</li>
<li>Flum, D. R., Dellinger, E. P., Cheadle, A., Chan, L., Koepsell, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Intraoperative+cholangiography+and+risk+of+common+bile+duct+injury+during+cholecystectomy%5BTitle%5D)+AND+%22JAMA%22%5BJournal%5D)">Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy.</a> JAMA. 289 (13), 1639-1644 (2003).</li>
<li>Wang, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((NIR-II+fluorescence-guided+liver+cancer+surgery+by+a+small+molecular+HDAC6+targeting+probe%5BTitle%5D)+AND+%22EBioMedicine%22%5BJournal%5D)">NIR-II fluorescence-guided liver cancer surgery by a small molecular HDAC6 targeting probe.</a> EBioMedicine. 98, 104880(2023).</li>
<li>Hu, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((First-in-human+liver-tumour+surgery+guided+by+multispectral+fluorescence+imaging+in+the+visible+and+near-infrared-I%2FII+windows%5BTitle%5D)+AND+%22Nat+Biomed+Eng%22%5BJournal%5D)">First-in-human liver-tumour surgery guided by multispectral fluorescence imaging in the visible and near-infrared-I/II windows.</a> Nat Biomed Eng. 4 (3), 259-271 (2020).</li>
<li>Lau, N. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Current+and+potential+applications+for+indocyanine+green+in+liver+transplantation%5BTitle%5D)+AND+%22Transplantation%22%5BJournal%5D)">Current and potential applications for indocyanine green in liver transplantation.</a> Transplantation. 106 (7), 1339-1350 (2022).</li>
<li>van den Bos, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Near-infrared+fluorescence+cholangiography+assisted+laparoscopic+cholecystectomy+%28FALCON%29%3A+An+international+multicentre+randomized+controlled+trial%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Near-infrared fluorescence cholangiography assisted laparoscopic cholecystectomy (FALCON): An international multicentre randomized controlled trial.</a> Surg Endosc. 37 (6), 4574-4584 (2023).</li>
<li>Wang, X. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+role+of+fluorescent+cholangiography+in+preventing+biliary+tract+injury+and+finding+bile+leakage%5BTitle%5D)+AND+%22Zhonghua+Yi+Xue+Za+Zhi%22%5BJournal%5D)">The role of fluorescent cholangiography in preventing biliary tract injury and finding bile leakage.</a> Zhonghua Yi Xue Za Zhi. 103 (16), 1242-1244 (2023).</li>
<li>Esposito, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Image-guided+pediatric+surgery+using+indocyanine+green+%28ICG%29+fluorescence+in+laparoscopic+and+robotic+surgery%5BTitle%5D)+AND+%22Front+Pediatr%22%5BJournal%5D)">Image-guided pediatric surgery using indocyanine green (ICG) fluorescence in laparoscopic and robotic surgery.</a> Front Pediatr. 8, 314(2020).</li>
<li>Cardenas, G., Fornaguera, I., Diaz Del Gobbo, R., Ginesta, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Direct+gallbladder+indocyanine+green+injection+technique+to+achieve+critical+view+of+safety+in+laparoscopic+cholecystectomy%5BTitle%5D)+AND+%22Cir+Esp+%28Engl+Ed%29%22%5BJournal%5D)">Direct gallbladder indocyanine green injection technique to achieve critical view of safety in laparoscopic cholecystectomy.</a> Cir Esp (Engl Ed). 99 (9), 678-682 (2021).</li>
<li>Castagneto-Gissey, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Intracholecystic+versus+intravenous+indocyanine+green+%28ICG%29+injection+for+biliary+anatomy+evaluation+by+fluorescent+cholangiography+during+laparoscopic+cholecystectomy%3A+a+case-control+study%5BTitle%5D)+AND+%22J+Clin+Med%22%5BJournal%5D)">Intracholecystic versus intravenous indocyanine green (ICG) injection for biliary anatomy evaluation by fluorescent cholangiography during laparoscopic cholecystectomy: a case-control study.</a> J Clin Med. 11 (12), 3508(2022).</li>
<li>Esposito, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Indocyanine+green+%28ICG%29+fluorescent+cholangiography+during+laparoscopic+cholecystectomy+using+RUBINA+technology%3A+Preliminary+experience+in+two+pediatric+surgery+centers%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA technology: Preliminary experience in two pediatric surgery centers.</a> Surg Endosc. 35 (11), 6366-6373 (2021).</li>
<li>Liu, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Investigation+of+the+optimal+indocyanine+green+dose+in+real-time+fluorescent+cholangiography+during+laparoscopic+cholecystectomy+with+an+ultra-high-definition+4K+fluorescent+system%3A+A+randomized+controlled+trial%5BTitle%5D)+AND+%22Updates+Surg%22%5BJournal%5D)">Investigation of the optimal indocyanine green dose in real-time fluorescent cholangiography during laparoscopic cholecystectomy with an ultra-high-definition 4K fluorescent system: A randomized controlled trial.</a> Updates Surg. 75 (7), 1903-1910 (2023).</li>
<li>Huang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Real-time+fluorescent+cholangiography+with+indocyanine+green+in+laparoscopic+cholecystectomy%3A+a+randomized+controlled+trial+to+establish+the+optimal+indocyanine+green+dose+within+30+min+preoperatively%5BTitle%5D)+AND+%22Surg+Today%22%5BJournal%5D)">Real-time fluorescent cholangiography with indocyanine green in laparoscopic cholecystectomy: a randomized controlled trial to establish the optimal indocyanine green dose within 30 min preoperatively.</a> Surg Today. 53 (2), 223-231 (2023).</li>
<li>Lopez-Sanchez, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Dose+and+administration+time+of+indocyanine+green+in+near-infrared+fluorescence+cholangiography+during+laparoscopic+cholecystectomy+%28DOTIG%29%3A+Study+protocol+for+a+randomised+clinical+trial%5BTitle%5D)+AND+%22BMJ+Open%22%5BJournal%5D)">Dose and administration time of indocyanine green in near-infrared fluorescence cholangiography during laparoscopic cholecystectomy (DOTIG): Study protocol for a randomised clinical trial.</a> BMJ Open. 13 (3), e067794(2023).</li>
<li>Esposito, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Clinical+application+and+technical+standardization+of+indocyanine+green+%28ICG%29+fluorescence+imaging+in+pediatric+minimally+invasive+surgery%5BTitle%5D)+AND+%22Pediatr+Surg+Int%22%5BJournal%5D)">Clinical application and technical standardization of indocyanine green (ICG) fluorescence imaging in pediatric minimally invasive surgery.</a> Pediatr Surg Int. 35 (10), 1043-1050 (2019).</li>
</ol>

The authors declare that they have no conflicts of interest to disclose.

Laparoscopic cholecystectomy (LC) has long been regarded as the gold standard treatment for cholelithiasis and cholecystitis. However, conventional surgical approaches often pose significant challenges in cases involving acute inflammation, gangrene, perforation, and anatomical variations-collectively referred to as difficult gallbladders16. These challenging conditions significantly increase the risks of bile duct injury (BDI) and cystic artery (CA) injury.
BDI is one ...

Approximately 20% of adults worldwide are affected by biliary stones, which can lead to acute cholecystitis -- a painful, rapidly progressing, and potentially life-threatening condition1. Timely surgical intervention is imperative for patients with cholecystitis. Laparoscopic cholecystectomy (LC) has become widely accepted as the standard treatment for this condition.
However, conventional surgical approaches may present significant challenges in complex cases. Severe inflammation or adhesions can render biliary tracts indistinct, increasing the risk of inadvertent injury to bile ducts or arteries2. Bile duct injury (BDI) is one of the most severe and common complications in these complex LC procedures. It often results in irreversible, lifelong consequences and, in severe cases, fatal outcomes3. Precise identification of critical biliary structures, such as Calot&#39;s triangle, is essential for facilitating surgical procedures and minimizing potential damage4.
Traditional intraoperative visualization techniques (IVT) integrate cholangiography, ultrasound, and choledochoscopy, enabling real-time monitoring of biliary tracts. However, concerns such as radiation exposure, a notable margin of error5, and cumbersome procedures have hindered the widespread adoption of IVT.
Near-infrared fluorescence (NIRF) is a cutting-edge technique that allows easy switching between fluorescence and white-light modes through a single laparoscope, enabling real-time visualization of biliary tracts during surgery. This technique offers high sensitivity, specificity, and tissue penetration capabilities6. NIRF can effectively prevent bile duct injury (BDI) during laparoscopic cholecystectomy (LC), particularly in complex cases involving severe inflammation or adhesions7.
Compared to traditional IVT, NIRF is easier to implement, provides clearer visualization of biliary tracts, and does not cause additional trauma8,9,10. Its fluorescent dye, indocyanine green (ICG), has been proven safe for human use by the Food and Drug Administration11. ICG is typically injected intravenously before surgery; however, the timing and dosage of ICG injection remain uncertain12,13. These factors are critical determinants of high-quality fluorescence imaging. Optimal ICG performance achieves a strong fluorescence signal in the bile ducts while minimizing background fluorescence from liver tissue14.
Through extensive exploration, we have identified the optimal timing and dosage of ICG injection as 0.25 mg administered 45 min preoperatively. This study aims to demonstrate the imaging effects of this timing and dosage in various complex surgical scenarios.

<table><tbody><tr><td>3-0 MERSILK</td><td>JOHNSON MEDICAL (CHINA) LTD.&amp;nbsp;</td><td>SA84G</td><td>The Suture Material</td></tr><tr><td>4-0 Coated VICRYL</td><td>ETHICON</td><td>VCP310</td><td>The Suture Material</td></tr><tr><td>Endoscopic Fluorescence Imaging System</td><td>ZHUHAI DI PU MEDICAL TECHNOLOGY CO., LTD.&amp;nbsp;</td><td>H380022041YF</td><td>Fluorescence Laparoscope Equipment</td></tr><tr><td>Hem-O-lock Clips</td><td>SINOLINKS MEDICAL INNOVOATION, INC.</td><td>B240714</td><td>Hem-O-lock Clips</td></tr><tr><td>Indocyanine Green for Injection</td><td>DANDONG YICHUANG PHARMACEUTICAL CO., LTD.&amp;nbsp;</td><td>H20055881</td><td>Fluorescence Dye</td></tr></tbody></table>

the role of indocyanine green fluorescence in complex laparoscopic cholecystectomy navigation

The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation

Laparoscopic cholecystectomy (LC) is the gold-standard treatment for cholelithiasis and cholecystitis. In difficult cases with severe inflammation and adhesions, the risk of bile duct injury (BDI) is significantly higher. Precise identification of anatomical biliary structures is essential to prevent such injuries. Conventional intraoperative visualization techniques (IVT) have limited clinical application due to their complexity, increased trauma, and high error rates. Near-infrared fluorescence (NIRF) imaging, utilizing indocyanine green (ICG) as a fluorescent dye, has emerged as an innovative IVT technique. It is increasingly recognized as a feasible, safe, and effective approach for LC. However, the efficacy of NIRF in difficult LC procedures remains unclear, and the optimal timing and dosage of ICG administration are yet to be established. This article outlines the main steps for performing fluorescence-guided difficult LC in a patient with acute gangrenous cholecystitis and evaluates the imaging effects of NIRF in various scenarios. The patient was positioned supine, with four trocars placed. Upon switching to fluorescence mode, the fluorescently labeled bile ducts were readily identified. Following fluorescence guidance, Calot's triangle was carefully dissected. The cystic duct (CD) and cystic artery (CA) were individually identified and clipped before the gallbladder was extracted. Finally, the surgical field was inspected in fluorescence mode to detect bile leakage. With satisfactory ICG imaging and a smooth procedure, the patient's postoperative recovery was uneventful. NIRF is a safe and effective technology that shows great promise for future clinical applications.

Following the surgical procedure outlined in the protocol (Figure 2), fluorescence-guided laparoscopic cholecystectomy (LC) was successfully performed in three patients with difficult gallbladders. There were no conversions to open surgery and no occurrences of bile duct injury (BDI) during the procedure. No bile leakage was observed in fluorescence mode, as demonstrated in the accompanying video. The intraoperative and postoperative outcomes are summarized in Table 1.
<...

This protocol outlines the steps for fluorescence-guided laparoscopic cholecystectomy and elucidates the role of fluorescence navigation in diverse surgical scenarios.

Laparoscopic cholecystectomy (LC) is the gold-standard treatment for cholelithiasis and cholecystitis. In difficult cases with severe inflammation and ...

the-role-indocyanine-green-fluorescence-complex-laparoscopic

Research

JoVE Journal

Medicine

This protocol presents Indocyanine Green-guided video-assisted retroperitoneal debridement (ICG-guided VARD) for treating severe acute necrotizing pancreatitis.

Indocyanine Green-Guided Intraoperative Imaging to Facilitate Video-Assisted Retroperitoneal Debridement for Treating Acute Necrotizing Pancreatitis

The present protocol describes fluorescent negative staining in laparoscopic central hepatectomy. This technique can make hepatectomy more accurate and precise.

Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining

Perihilar cholangiocarcinoma (pCCA) is a highly malignant and aggressive tumor, with radical resection being the only curative treatment available. With continuous advancements in laparoscopic techniques and instruments, laparoscopic radical surgery for pCCA is now considered technically safe and feasible. However, due to the high complexity of the surgery and the lack of evidence-based clinical support, laparoscopic radical surgery for type IIIb pCCA is performed only in a few large...

Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb

Here, we present a protocol for laparoscopic anatomical hepatectomy using Takasaki's approach and indocyanine green fluorescence navigation in S4/5/7/8 resection.

Laparoscopic Anatomical Hepatectomy Using Takasaki's Approach and Indocyanine Green Fluorescence Navigation

The integrated technique described in this protocol achieves real-time biliary mapping via indocyanine green (ICG) fluorescence, minimally invasive stone clearance under direct visualization, and secure primary duct repair (6-0 PDS), eliminating T-tube drainage.

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind.

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Indocyanine Green Angiography (or ICGA) performed by tail vein injection provides high quality ICGA time course images to characterize abnormalities in mouse choroid.

Detecting Abnormalities in Choroidal Vasculature in a Mouse Model of Age-related Macular Degeneration by Time-course Indocyanine Green Angiography

The protocol describes the fabrication of fully colored three-dimensional prints of patient-specific, anatomical skull models to be used for surgical simulation. The crucial steps of combining different imaging modalities, image segmentation, three-dimensional model extraction, and production of the prints are explained.

Multicolor 3D Printing of Complex Intracranial Tumors in Neurosurgery

Robotic liver surgery has gained more acceptance as a feasible, safe, and effective procedure for the treatment of both benign and malignant indications. However, robotic left hepatectomy is still technically demanding. We describe our surgical technique of a robotic left hepatectomy using indocyanine green fluorescence imaging for a large biliary cyst.

Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst

Dynamic navigation systems (DNS) provide real-time visualization and guidance to the operator during endodontic access cavities preparation. The planning of the procedure requires three-dimensional imaging utilizing cone beam computed tomography and surface scans. After the export of the planning data to the DNS, access cavities can be prepared with minimal invasion.

Dynamic Navigation in Endodontics: Guided Access Cavity Preparation by Means of a Miniaturized Navigation System

Learn fluorescence-guided laparoscopic cholecystectomy using indocyanine green injection and DPMI imaging. This technique enhances bile duct visualization and reduces surgical complications in complex procedures.

The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation

Explore More Videos