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Indocyanine Green Fluorescence Imaging for Intraoperative Confirmation of Bile Flow from Hilar Microbile Ducts during
Muhammed Jaseel1, Anu K Vasudevan2, Abhinav Sihag1
1Department of Paediatric Surgery, CHILDS Trust Medical Research Foundation, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India.
Insights
Indocyanine green (ICG) fluorescence imaging effectively identifies bile flow during Kasai portoenterostomy (KPE). Good bile flow observed during surgery accurately predicts successful jaundice clearance in infants.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Surgical Imaging
Background:
- Kasai portoenterostomy (KPE) is a critical procedure for biliary atresia.
- Accurate assessment of bile flow from hilar microbile ducts is essential for KPE success.
- Identifying intraoperative indicators of successful bile flow remains a challenge.
Purpose of the Study:
- To evaluate the utility of indocyanine green (ICG) fluorescence imaging in visualizing bile flow during KPE.
- To determine the correlation between intraoperative ICG-identified bile flow and postoperative jaundice clearance.
Main Methods:
- Retrospective review of KPE cases over 10 months.
- Administration of ICG (0.1 mg/kg) 12 hours prior to surgery in select patients.
- Intraoperative assessment of bile flow using ICG fluorescence imaging and correlation with surgical outcomes.
Main Results:
- Eleven of fifteen children undergoing KPE received ICG.
- Good bile flow from the hilar plate was observed in seven children, with six achieving jaundice clearance.
- Poor bile flow was associated with failure to clear jaundice in all four cases.
- ICG imaging predicted jaundice clearance with 91% accuracy (10/11 children).
Conclusions:
- ICG fluorescence imaging is a valuable tool for assessing bile flow during KPE.
- Intraoperative identification of good bile flow using ICG correlates strongly with successful jaundice clearance.
Aim:
We studied the usefulness of indocyanine green (ICG) fluorescence imaging in identifying bile flow from hilar microbile ducts during Kasai portoenterostomy (KPE).
Materials And Methods:
We reviewed the records of all the children who underwent KPE over 10 months and reviewed the operation notes of those who received ICG. ICG (0.1 mg/kg) was injected into a peripheral vein 12 h before the incision. We noted the surgeon's observation on bile flow after hilar dissection using ICG camera (KARL STORZ). The outcome of KPE (jaundice clearance with direct bilirubin of <2 mg/dL) was correlated with the bile flow identified by the surgeon and results were computed.
Results:
Fifteen children underwent KPE during this period, out of which 11 children received ICG. After dissection of the hilar plate, good bile drainage was observed from the right and left corners of the portal plate in seven children. Six of these children with good bile flow have been observed to be clearing jaundice. One child despite having good bile flow did not clear jaundice. All four children who had poor bile flow failed to clear jaundice. In children who had received ICG, we were able to predict jaundice clearance with an accuracy of 91% (10 out of 11 children).
Conclusion:
ICG can be used effectively to identify bile flow during KPE and good bile flow observed during surgery correlates with jaundice clearance.
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