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Updated: Sep 12, 2025
The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation
Published on: January 31, 2025
Indocyanine green intravenous administration can more accurately identify the intersegmental plane than the
Takahiro Ochi1, Yuichi Sakairi1,2, Yuki Sata1
1Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Background:
Indocyanine green (ICG) intravenous administration (ICG-iv) has been described for detecting the intersegmental plane in lung segmentectomy. However, errors with preoperative planning and accuracy comparisons with alternative methodologies have not been fully validated.
Methods:
This single-center retrospective study identified 138 patients with 140 lesions who underwent segmentectomy using the inflation-deflation (I-D) method or ICG-iv method. The planned margin was calculated using three-dimensional imaging, and the surgical margin was measured for the resected specimen. We evaluated the surgical and planned margin ratio (S/P ratio) and log S/P ratio. Accuracy was also tested using the Root Mean Squared Logarithmic Error (RMSLE): the smaller the RMSLE, the more accurate.
Results:
The study enrolled 86 patients with 88 lesions in the I-D group and 52 patients with lesions in the ICG-iv group. All lesions were completely resected. The ICG-iv group underwent significantly more complex segmentectomies compared to the I-D group (P < 0.001). The median S/P ratio was 0.886 (I-D) and 0.912 (ICG-iv). The mean log S/P ratio was -0.061 (I-D) and -0.013 (ICG-iv). The RMSLE values were 0.258 (I-D) and 0.229 (ICG-iv). In the ICG-iv group, eight patients with lesions (15.3%) had poor staining for intersegmental identification. Notably, the poor staining subgroup included a higher proportion of patients with obstructive pulmonary disease (4/8: 50.0%) compared to the good staining group (6/44: 13.6%) (P = 0.035).
Conclusions:
The ICG-iv method demonstrated superior accuracy in identifying the intersegmental plane compared to I-D method; however, concerns persist regarding suboptimal staining in patients with obstructive pulmonary disease.
