Optimizing the image of fluorescence cholangiography using ICG: a systematic review and ex vivo experiments

Jacqueline van den Bos*, Fokko P. Wieringa, Nicole D. Bouvy, Laurents P. S. Stassen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

20 Citations (Web of Science)

Abstract

BackgroundThough often only briefly described in the literature, there are clearly factors that have an influence on the fluorescence intensity, and thereby the usefulness of the technique. This article aims to provide an overview of the factors influencing the fluorescence intensity of fluorescence imaging with Indocyanine green, primarily focussed on NIRF guided cholangiography.MethodsA systematic search was conducted to gain an overview of currently used methods in NIRF imaging in laparoscopic cholecystectomies. Relevant literature was searched to gain advice on what methods to use. Ex vivo experiments were performed to assess various factors that influence fluorescence intensity and whether the found clinical advices can be confirmed.ResultsICG is currently the most widely applied fluorescent dye. Optimal ICG concentration lies between 0.00195 and 0.025mg/ml, and this dose should be given as early as achievablebut maximum 24hbefore surgery. When holding the laparoscope closer and perpendicular to the dye, the signal is most intense. In patients with a higher BMI and/or cholecystitis, fluorescence intensity is lower, but NIRF seems to be more helpful. There are differences between various marketed fluorescence systems. Also, no uniform method to assess fluorescence intensity is available yet.ConclusionsThis study identified and discussed several factors that influence the signal of fluorescence cholangiography. These factors should be taken into account when using NIRF cholangiography. Also, surgeons should be aware of new dyes and clinical systems, in order to benefit most from the potential of NIRF imaging.

Original languageEnglish
Pages (from-to)4820-4832
Number of pages13
JournalSurgical endoscopy and other interventional techniques
Volume32
Issue number12
DOIs
Publication statusPublished - Dec 2018

Keywords

  • Indocyanine green
  • Near-infrared fluorescence imaging
  • NIRF
  • Fluorescence intensity
  • NEAR-INFRARED-FLUORESCENCE
  • BILE-DUCT INJURY
  • LIGHT-ABSORBING PROPERTIES
  • QUALITY-OF-LIFE
  • INDOCYANINE-GREEN
  • LAPAROSCOPIC CHOLECYSTECTOMY
  • INTRAOPERATIVE CHOLANGIOGRAPHY
  • BILIARY ANATOMY
  • GUIDED SURGERY
  • ROUTINE USE

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