In the realm of laparoscopic cholecystectomy, the delineation of the biliary tree plays a crucial role in ensuring surgical precision and safety. To enhance this visualization, the use of fluorescence cholangiography with indocyanine green (ICG) has emerged as a promising technique. Traditionally, ICG is administered intravenously, but recent studies have explored the direct injection of ICG into the gallbladder as an alternative method.
The study conducted by Elmeligy et al. compared the efficacy of intravenous ICG administration (IV-ICG) versus transhepatic intracholecystic injection of ICG (IC-ICG) in outlining the biliary tree during laparoscopic cholecystectomy. Sixty patients with chronic and acute gallbladder disease participated in this prospective randomized clinical study, which took place at the Surgical Department of Theodor Bilharz Research Institute between 2022 and 2024.
The results of the study revealed that while the total operating time was not significantly different between the IV-ICG and IC-ICG groups, the IV-ICG method was more accurate in identifying certain biliary structures such as the duodenum and common hepatic duct. Additionally, the study found that the IC-ICG route provided a clearer visualization of the biliary anatomy by avoiding hepatic fluorescence, thus improving the bile duct-to-liver contrast.
The authors recommended the use of both IV-ICG and IC-ICG techniques in cases of acute cholecystitis with cystic duct obstruction. They also suggested that in cases of liver cirrhosis, the transhepatic IC-ICG method might be preferred over IV-ICG due to its advantages in avoiding hepatic fluorescence. Overall, the study highlighted the potential benefits of ICG-fluorescence cholangiography in aiding surgeons in identifying the extrahepatic biliary anatomy during laparoscopic cholecystectomy.
The research presented by Elmeligy et al. contributes to the evolving landscape of surgical techniques aimed at enhancing the safety and precision of laparoscopic procedures. By exploring different methods of ICG administration and their impact on biliary tree visualization, the study sheds light on potential strategies to reduce the risk of bile duct injuries and improve surgical outcomes in patients undergoing cholecystectomy.
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