Feasibility of Indocyanine Green Fluorescent Cholangiography Via Inguinal Nodal Injection Approach in...

Fluorescent cholangiography (FC) with indocyanine green (ICG) is an alternative to intraoperative cholangiography (IOC) for visualizing the biliary tract during surgery. This pilot study assessed the feasibility of ICG-FC using inguinal nodal injection in patients undergoing upper gastrointestinal cancer surgery. Under sonographic guidance, ICG was injected into inguinal nodes bilaterally (each side 2.5 mg, total 5 mg) after induction of anesthesia. Laparoscopic cholecystectomy (CHE) and laparoscopic hepatoduodenal ligament clearance (HDL) were performed in 24 cases. ICG-FC was utilized for real-time visualization of extrahepatic biliary anatomy. In CHE cases, ICG-FC provided 100% visualization of the gall bladder (GB), common bile duct (CBD), common hepatic duct (CHD), cystic duct (CD), and CD-CBD junction. For HDL, the visualization rates were 100% for the GB, CHD, and CBD, but only 50% for the undissected CD. Fluorescence appeared in the biliary tree soon after injection and remained throughout the duration of surgery with minimal interference from background hepatic fluorescence. No adverse reactions to ICG were observed. ICG-FC via the inguinal nodal route is safe and feasible, enabling real-time dissection of the calot's triangle and hepatoduodenal ligament. It offers reliable visualization of key biliary structures, showing promise as an alternative to IOC in upper gastrointestinal cancer surgeries.