Fluorescent Cholangiogram-Optimal Dose and Timing

A bile duct injury (BDI) is a serious complication of laparoscopic cholecystectomy (LC). In the United States the reported incidence is about 0.2%, with approximately 750,000 LCs performed annually. Fluorescent cholangiogram (FC) with indocyanine green (ICG) is a novel technique aimed at reducing the incidence of BDI. Still, there are differences regarding the optimal doze and timing of ICG administration prior to LC.

We performed FC with 3 different doses of ICG (0.05 mg/kg, 1 and 2 mg) injected at 3 different time intervals prior to LC (1, 3, and 6 hours) for a total of 9 different visualizations. Images of the visualized of bile tree anatomy were obtained under white light and near infrared light (NIR) for all cases. A survey questionnaire was prepared and sent out to practitioners via Google Form.

A total of 122 people completed the survey. Most of them preferred visualization with 1-mg ICG injected 3 hours preoperatively. Only 16% of practitioners reported routine use of FC, however 87% found the method useful. When asked if they were willing to use the method routinely, specialists were significantly more likely to respond with "No" (χ² = 4.438, df = 1, P = .035, ϕ = -0.191).

FC is a useful technique that is still not widely adopted, but has a high level of appreciation for its usefulness.