Fluorescence Guided Cholecystectomy by a Single Group: Initial 47 Procedures Experience in Mexico

Fluorescence guided surgery (FGS) for biliary surgery uses indocyanine green (ICG), a specific dye that is eliminated almost exclusively by the liver and biliary system, making it very useful for an adequate and safe visualization of biliary tract structures.

We present our experience with FGS for cholecystectomy multiport and single port, including all patients older than 18 years of age, with diagnosis of cholecystitis (acute and chronic), from October 18, 2018 to December 30, 2021.

A total of 47 patients were managed with FGS cholecystectomy, mean age was 61.2 (± 17.7) years, 31 (65.9%) were female and 16 (34.1%) males. Twenty-four (51.1%) were emergency procedures, due to acute cholecystitis, of which 10 (41.7%) presented with an infected gallbladder (Parkland 3 to 5) and three (12.5%) presented with related acute pancreatitis, the remaining 23 (48.9%) cases were elective surgeries, due to chronic cholecystitis. Visualization of laparoscopic fluorescence of the biliary ducts was achieved in 45 of the 47 patients (95.7%). Mean time for biliary tract structures visual identification was 8 minutes and 40 seconds (± 7 minutes, 20 seconds), fluorescence allowed the visualization of biliary tract anatomical variants in two patients.

The reported rate of biliary structures visualization using ICG is relatively variable, ranging from 25% to 100%, in our group it was 95.7% due to our protocol.

ICG utilization for cholecystectomy is very useful and helps for a safe procedure even in difficult surgeries, we believe that it should be used in everyday practice.