The value of indocyanine green fluorescence imaging in reducing the rate of bile duct injury during laparoscopic cholecystectomy
Objective:To investigate the value of using indocyanine green fluorescence to develop extrahepatic bile ducts and reduce the incidence of bile duct injury in laparoscopic cholecystectomy.Methods:Between Feb.2023 and Aug.2023,276 patients with benign gallbladder diseases underwent laparoscopic cholecystectomy by the same surgical group,with the same surgical equipment.Patients were injected with 2.5 mg indocyanine green 6-10 h before surgery for surgical pretreatment.During the operation,the extrahe-patic bile ducts were identified using two modes:white light laparoscopy and fluorescence laparoscopy.The accuracy of two methods in identifying extrahepatic bile ducts were compared.Results:Among the 276 patients,263 cases were accurately identified for structures such as the common hepatic duct,common bile duct,and cystic duct under fluorescence mode,while 250 cases were accurately identi-fied under white light mode,there was statistically significant difference between the two groups(P<0.05).For cases that could be accurately identified under fluorescence laparoscopy,laparoscopic cholecystectomy was performed.For cases couldn't be accurately identified under fluorescence laparoscopy,laparoscopic partial cholecystectomy or conversion to open surgery was used.During the iden-tification process,if there was accidental damage of blood vessels or suspicion of damage to the common bile duct,surgery was comple-ted through open surgery.No bile duct injury was found during follow-up for more than 2 months after surgery.Conclusions:Indocyanine green fluorescence in the development of extrahepatic bile duct during laparoscopic cholecystectomy can increase the accuracy of identifying important bile duct structures.Adopting appropriate surgical methods based on local anatomical identification can reduce the risk of bile duct injury.
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