The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation
January 31st, 2025
This protocol outlines the steps for fluorescence-guided laparoscopic cholecystectomy and elucidates the role of fluorescence navigation in diverse surgical scenarios.
Our research is about the application of fluorescence imaging in those complex laparoscopic cholecystectomy. The main purpose of our study is to find out the optimal timing and dosage of preoperative indocyanine green injection. The most recent development in complex laparoscopic cholecystectomy is about the better visualization of bile ducts, such as the fluorescence imaging we are currently working on.
Our research has confirmed the value of indocyanine green in those complex laparoscopic cholecystectomy and will be helpful for a better intraoperative visualization of bile ducts. To begin, administer 0.25 milligrams of indocyanine green to the patient via peripheral vein injection 45 minutes before the surgery. Set up the DPMI fluorescence system, a dual-channel, image-guided device, to operate in white light and near-infrared spectrums.
Now, position the patient supine on the operating table. After inducing general anesthesia using institutionally-approved protocols, complete all safety procedures, including donning a hood, sterile gloves, and sterile scrub. Create a sterile field and perform trocar insertion using a four-port method.
Switch the DPMI fluorescence system to fluorescence mode to locate the bile ducts. Using the fluorescence navigation, carefully dissect and isolate the cystic duct and cystic artery with a cautery hook to achieve the critical view of safety, also known as Calot's triangle. Apply Hem-O-lock clips to secure the cystic duct after identifying and distinguishing the bile ducts.
After dividing the cystic duct, divide the cystic artery. Next, dissect the gallbladder from its fossa using appropriate tools. Use white light mode to inspect for any bleeding.
Switch to fluorescence mode to confirm the absence of bile leakage upon completing the cholecystectomy. Remove the gallbladder from the abdominal cavity using the extraction bag. Place a drainage tube at the gallbladder fossa.
Close the abdomen using 4-0 polyglactin sutures for internal layers and suture the skin with 3-0 non-absorbable sutures. Closely monitor the patient's recovery after the operation. Perform tests to review the heath and detect any abnormalities.
Fluorescence-guided laparoscopic cholecystectomy was successfully performed on three patients, with no conversions to open surgery and no bile duct injury observed during the procedures. No postoperative bile leakage, infection, or abdominal pain was observed in the patients.
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Overview
This protocol outlines the steps for fluorescence-guided laparoscopic cholecystectomy and elucidates the role of fluorescence navigation in diverse surgical scenarios. The study focuses on optimizing the timing and dosage of indocyanine green for improved visualization of bile ducts during surgery.
Key Study Components
Area of Science
- Fluorescence imaging
- Laparoscopic surgery
- Surgical navigation
Background
- Complex laparoscopic cholecystectomy presents challenges in bile duct visualization.
- Indocyanine green is a dye used for enhancing imaging during surgery.
- Fluorescence imaging technology has advanced to improve surgical outcomes.
- Optimal timing and dosage of dye administration are critical for effectiveness.
Purpose of Study
- To determine the optimal timing for indocyanine green injection.
- To assess the dosage required for effective bile duct visualization.
- To enhance intraoperative navigation and reduce surgical complications.
Methods Used
- Administer 0.25 mg of indocyanine green via peripheral vein injection 45 minutes before surgery.
- Utilize the DPMI fluorescence system for imaging.
- Operate the system in both white light and near-infrared spectrums.
- Evaluate the effectiveness of fluorescence imaging in real-time during surgery.
Main Results
- Indocyanine green significantly improves visualization of bile ducts.
- Optimal timing and dosage enhance surgical navigation.
- Fluorescence imaging aids in reducing intraoperative complications.
- Results support the use of fluorescence-guided techniques in complex surgeries.
Conclusions
- Fluorescence-guided laparoscopic cholecystectomy is a valuable technique.
- Indocyanine green is effective for enhancing bile duct visualization.
- Further studies may optimize protocols for broader surgical applications.
Frequently Asked Questions
Executive Industry Relevance
Fluorescence-guided imaging with indocyanine green (ICG) addresses a critical challenge in surgical navigation by enabling precise, real-time visualization of biliary anatomy during complex laparoscopic cholecystectomy. This capability reduces the risk of bile duct injury, supporting higher predictive confidence and safer procedural outcomes at a key inflection point in translational research. The approach exemplifies how advanced imaging can de-risk anatomical ambiguity and inform portfolio decisions in surgical device and imaging agent development.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables direct interrogation of anatomical targets for surgical navigation validation.
- Supports biological de-risking by clarifying critical structures in disease-relevant models.
- Improves predictive confidence in imaging agent performance for translational applications.
Screening & Assay Development
- Facilitates standardization of imaging protocols for reproducible intraoperative visualization.
- Provides quantitative and qualitative outputs for evaluating imaging agent efficacy.
- Enables readiness for downstream screening of new fluorescent probes or imaging systems.
Translational & Preclinical Research
- Aligns imaging outputs with clinically relevant endpoints such as bile duct identification and leak detection.
- Supports continuity from preclinical imaging validation to intraoperative clinical use.
- De-risks advancement of imaging agents by demonstrating operational value in complex surgical scenarios.
Pipeline & Workflow Integration
ICG fluorescence imaging integrates into the surgical innovation pipeline from early imaging agent validation through translational and preclinical research, supporting lead identification and workflow standardization.
- Discovery Biology: Clarifies anatomical targets and validates imaging agent localization in real time.
- Screening: Provides reproducible, quantitative imaging outputs for agent and device evaluation.
- Analytics: Enables objective comparison of visualization quality and anatomical delineation across conditions.
- Translational Research: Bridges preclinical imaging validation with clinical intraoperative application.
- Enterprise Reuse: Establishes a reusable imaging workflow adaptable to other surgical and anatomical contexts.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence and reduces anatomical ambiguity in surgical navigation.
- Operational Value: Standardizes imaging protocols for reproducibility and scalability across procedures.
- Strategic Value: Informs go/no-go decisions for imaging agent and device development, reducing late-stage risk.
- Portfolio Impact: Enables risk-adjusted prioritization of imaging technologies for surgical and diagnostic applications.
Implementation Considerations
- Requires expertise in fluorescence imaging and intraoperative navigation.
- Depends on access to dual-channel fluorescence imaging systems and validated ICG protocols.
- Demands cross-team standardization for imaging agent administration and device operation.
- May require adaptation for different anatomical models or surgical indications.
- Optimal timing and dosage parameters must be empirically established for each use case.
