Introduction
Laparoscopic cholecystectomy (LC) is one of the most performed surgeries worldwide. Biliary tract injuries are among the most feared complications after LC. The primary cause of biliary injuries during LC is the incorrect identification of the biliary tract anatomy. Near-infrared fluorescence (NIRF) imaging, following intravenous (IV) injection of indocyanine green (ICG), shows promise for simplifying the intraoperative visualization of biliary anatomy. This technique enables real-time identification of the cystic duct and common bile duct, potentially enhancing the outcomes of LC. This systematic review and meta-analysis aimed to investigate the effects of NIRF-ICG on LC outcomes.
Aims & Methods
This meta-analysis followed the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus until May 23rd, 2024. We included randomized-controlled trials and retrospective studies comparing NIRF-ICG LC and conventional LC. Statistical analysis was performed using Review Manager 5.3 software.
Results
Fifteen studies with 1581 patients (41.1%) in the NIRF-ICG group and 2264 (58.9%) in the control group were included. The NIRF-ICG was associated with statistically significant reduced overall complications, bile leakage, and duct drainage (risk ratio (RR) = 0.62, 95% CI: [0.40, 0.95], P = 0.03; Fig 1), (RR = 0.34, 95% CI: [0.14, 0.83], P = 0.02; Fig 2), and (RR = 0.64, 95% CI: [0.44, 0.91]), P = 0.01; Fig 3), respectively. Common bile duct (CBD), cystic duct- CBD junction, and common hepatic duct visualization rates were better with the NIRF-ICG, (RR= 3.67, 95% CI: [2.62, 5.15], P < 0.001), (RR = 3.00, 95% CI: [2.03, 4.43], P < 0.001), and (RR = 2.87, 95% CI: [1.94, 4.25], P < 0.001), respectively. There was no significant difference in cystic duct visualization rate (RR = 1.40, 95% CI: [0.71, 2.78], P = 0.33).
Conclusion
NIRF following administration of ICG in LC offers better visualization of biliary tract anatomy and is associated with reduced overall complications, bile leakage, and bile duct drainage.
References
1. J. Van Den Bos et al., “Near-infrared fluorescence cholangiography assisted laparoscopic cholecystectomy (FALCON): an international multicentre randomized controlled trial,” Surg Endosc, vol. 37, no. 6, pp. 4574–4584, Jun. 2023, doi: 10.1007/s00464-023-09935-6.
2. W. H. She et al., “Routine use of ICG to enhance operative safety in emergency laparoscopic cholecystectomy: a randomized controlled trial,” Surg Endosc, vol. 36, no. 6, pp. 4442–4451, Jun. 2022, doi: 10.1007/s00464-021-08795-2.
3. J. K. Koong, G. H. Ng, K. Ramayah, P. S. Koh, and B. K. Yoong, “Early identification of the critical view of safety in laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography: A randomised controlled study,” Asian Journal of Surgery, vol. 44, no. 3, pp. 537–543, Mar. 2021, doi: 10.1016/j.asjsur.2020.11.002.