TY - JOUR
T1 - Fluorescence-based cholangiography
T2 - preliminary results from the IHU-IRCAD-EAES EURO-FIGS registry
AU - Agnus, Vincent
AU - Pesce, Antonio
AU - Boni, Luigi
AU - Van den Bos, Jacqueline
AU - Morales-Conde, Salvador
AU - Paganini, Alessandro M.
AU - Quaresima, Silvia
AU - Balla, Andrea
AU - La Greca, Gaetano
AU - Plaudis, Haralds
AU - Moretto, Gianluigi
AU - Castagnola, Maurizio
AU - Santi, Caterina
AU - Casali, Lorenzo
AU - Tartamella, Luciano
AU - Saadi, Alend
AU - Picchetto, Andrea
AU - Arezzo, Alberto
AU - Marescaux, Jacques
AU - Diana, Michele
PY - 2020/9
Y1 - 2020/9
N2 - Introduction Near-infrared fluorescence cholangiography (NIRF-C) is a popular application of fluorescence image-guided surgery (FIGS). NIRF-C requires near-infrared optimized laparoscopes and the injection of a fluorophore, most frequently Indocyanine Green (ICG), to highlight the biliary anatomy. It is investigated as a tool to increase safety during cholecystectomy. The European registry on FIGS (EURO-FIGS: ) aims to obtain a snapshot of the current practices of FIGS across Europe. Data on NIRF-C are presented. Methods EURO-FIGS is a secured online database which collects anonymized data on surgical procedures performed using FIGS. Data collected for NIRF-C include gender, age, Body Mass Index (BMI), pathology, NIR device, ICG dose, ICG timing of administration before intraoperative visualization, visualization (Y/N) of biliary structures such as the cystic duct (CD), the common bile duct (CBD), the CD-CBD junction, the common hepatic duct (CHD), Visualization scores, adverse reactions to ICG, operative time, and surgical complications. Results Fifteen surgeons (12 European surgical centers) uploaded 314 cases of NIRF-C during cholecystectomy (cholelithiasis n = 249, cholecystitis n = 58, polyps n = 7), using 4 different NIR devices. ICG doses (mg/kg) varied largely (mean 0.28 +/- 0.17, median 0.3, range: 0.02-0.62). Similarly, injection-to-visualization timing (minutes) varied largely (mean 217 +/- 357; median 57), ranging from 1 min (direct intragallbladder injection in 2 cases) to 3120 min (n = 2 cases). Visualization scores before dissection were significantly correlated, at univariate analysis, with ICG timing (all structures), ICG dose (CD-CBD), device (CD and CD-CBD), surgeon (CD and CD-CBD), and pathology (CD and CD-CBD). BMI was not correlated. At multivariate analysis, pathology and timing remained significant factors affecting the visualization scores of all three structures, whereas ICG dose remained correlated with HD visualization only. Conclusions The EURO-FIGS registry has confirmed a wide disparity in ICG dose and timing in NIRF-C. EURO-FIGS can represent a valuable tool to promote and monitor FIGS-related educational and consensus activities in Europe.
AB - Introduction Near-infrared fluorescence cholangiography (NIRF-C) is a popular application of fluorescence image-guided surgery (FIGS). NIRF-C requires near-infrared optimized laparoscopes and the injection of a fluorophore, most frequently Indocyanine Green (ICG), to highlight the biliary anatomy. It is investigated as a tool to increase safety during cholecystectomy. The European registry on FIGS (EURO-FIGS: ) aims to obtain a snapshot of the current practices of FIGS across Europe. Data on NIRF-C are presented. Methods EURO-FIGS is a secured online database which collects anonymized data on surgical procedures performed using FIGS. Data collected for NIRF-C include gender, age, Body Mass Index (BMI), pathology, NIR device, ICG dose, ICG timing of administration before intraoperative visualization, visualization (Y/N) of biliary structures such as the cystic duct (CD), the common bile duct (CBD), the CD-CBD junction, the common hepatic duct (CHD), Visualization scores, adverse reactions to ICG, operative time, and surgical complications. Results Fifteen surgeons (12 European surgical centers) uploaded 314 cases of NIRF-C during cholecystectomy (cholelithiasis n = 249, cholecystitis n = 58, polyps n = 7), using 4 different NIR devices. ICG doses (mg/kg) varied largely (mean 0.28 +/- 0.17, median 0.3, range: 0.02-0.62). Similarly, injection-to-visualization timing (minutes) varied largely (mean 217 +/- 357; median 57), ranging from 1 min (direct intragallbladder injection in 2 cases) to 3120 min (n = 2 cases). Visualization scores before dissection were significantly correlated, at univariate analysis, with ICG timing (all structures), ICG dose (CD-CBD), device (CD and CD-CBD), surgeon (CD and CD-CBD), and pathology (CD and CD-CBD). BMI was not correlated. At multivariate analysis, pathology and timing remained significant factors affecting the visualization scores of all three structures, whereas ICG dose remained correlated with HD visualization only. Conclusions The EURO-FIGS registry has confirmed a wide disparity in ICG dose and timing in NIRF-C. EURO-FIGS can represent a valuable tool to promote and monitor FIGS-related educational and consensus activities in Europe.
KW - Near-infrared fluorescence cholangiography
KW - Fluorescence-guided surgery
KW - Image-guided surgery
KW - Registry
KW - NEAR-INFRARED-FLUORESCENCE
KW - INDOCYANINE GREEN
KW - GUIDED SURGERY
KW - ROUTINE USE
KW - CHOLECYSTECTOMY
U2 - 10.1007/s00464-019-07157-3
DO - 10.1007/s00464-019-07157-3
M3 - Article
C2 - 31591654
VL - 34
SP - 3888
EP - 3896
JO - Surgical endoscopy and other interventional techniques
JF - Surgical endoscopy and other interventional techniques
SN - 0930-2794
IS - 9
ER -