Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: Results of an international Delphi survey

Fernando Dip; Julio Aleman; Esther DeBoer; Luigi Boni; Michael Bouvet; Nicholas Buchs; Thomas Carus; Michele Diana; Enrique F Elli; Merlijn Hutteman; Takeaki Ishizawa; Norihiro Kokudo; Emanuele Lo Menzo; Kaja Ludwig; Edward Phillips; Jean Marc Regimbeau; Homero Rodriguez-Zentner; Mayank Dramani Roy; Sylke Schneider-Koriath; Rutger M Schols; Danny Sherwinter; Conrad Simpfendorfer; Laurent Stassen; Samuel Szomstein; Alexander Vahrmeijer; Floris P R Verbeek; Matthew Walsh; Kevin P White; Raul J Rosenthal

doi:10.1016/j.surg.2022.07.012

Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: Results of an international Delphi survey

Fernando Dip, Julio Aleman, Esther DeBoer, Luigi Boni, Michael Bouvet, Nicholas Buchs, Thomas Carus, Michele Diana, Enrique F Elli, Merlijn Hutteman, Takeaki Ishizawa, Norihiro Kokudo, Emanuele Lo Menzo, Kaja Ludwig, Edward Phillips, Jean Marc Regimbeau, Homero Rodriguez-Zentner, Mayank Dramani Roy, Sylke Schneider-Koriath, Rutger M ScholsDanny Sherwinter, Conrad Simpfendorfer, Laurent Stassen, Samuel Szomstein, Alexander Vahrmeijer, Floris P R Verbeek, Matthew Walsh, Kevin P White, Raul J Rosenthal^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Published empirical data have increasingly suggested that using near-infrared fluorescence cholangiography during laparoscopic cholecystectomy markedly increases biliary anatomy visualization. The technology is rapidly evolving, and different equipment and doses may be used. We aimed to identify areas of consensus and nonconsensus in the use of incisionless near-infrared fluorescent cholangiography during laparoscopic cholecystectomy.

METHODS: A 2-round Delphi survey was conducted among 28 international experts in minimally invasive surgery and near-infrared fluorescent cholangiography in 2020, during which respondents voted on 62 statements on patient preparation and contraindications (n = 12); on indocyanine green administration (n = 14); on potential advantages and uses of near-infrared fluorescent cholangiography (n = 18); comparing near-infrared fluorescent cholangiography with intraoperative x-ray cholangiography (n = 7); and on potential disadvantages of and required training for near-infrared fluorescent cholangiography (n = 11).

RESULTS: Expert consensus strongly supports near-infrared fluorescent cholangiography superiority over white light for the visualization of biliary structures and reduction of laparoscopic cholecystectomy risks. It also offers other advantages like enhancing anatomic visualization in obese patients and those with moderate to severe inflammation. Regarding indocyanine green administration, consensus was reached that dosing should be on a milligrams/kilogram basis, rather than as an absolute dose, and that doses >0.05 mg/kg are necessary. Although there is no consensus on the optimum preoperative timing of indocyanine green injections, the majority of participants consider it important to administer indocyanine green at least 45 minutes before the procedure to decrease the light intensity of the liver.

CONCLUSION: Near-infrared fluorescent cholangiography experts strongly agree on its effectiveness and safety during laparoscopic cholecystectomy and that it should be used routinely, but further research is necessary to establish optimum timing and doses for indocyanine green.

Original language	English
Pages (from-to)	S21-S28
Number of pages	8
Journal	Surgery
Volume	172
Issue number	6
DOIs	https://doi.org/10.1016/j.surg.2022.07.012
Publication status	Published - Dec 2022

Keywords

Humans
Indocyanine Green
Cholecystectomy, Laparoscopic/methods
Cholangiography/methods
Optical Imaging
Coloring Agents

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10.1016/j.surg.2022.07.012Licence: CC BY-NC-ND

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Dip, F., Aleman, J., DeBoer, E., Boni, L., Bouvet, M., Buchs, N., Carus, T., Diana, M., Elli, E. F., Hutteman, M., Ishizawa, T., Kokudo, N., Lo Menzo, E., Ludwig, K., Phillips, E., Regimbeau, J. M., Rodriguez-Zentner, H., Roy, M. D., Schneider-Koriath, S., ... Rosenthal, R. J. (2022). Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: Results of an international Delphi survey. Surgery, 172(6), S21-S28. https://doi.org/10.1016/j.surg.2022.07.012

@article{9bf58f9afb2f48cf88e5e0e7779cc897,

title = "Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: Results of an international Delphi survey",

abstract = "BACKGROUND: Published empirical data have increasingly suggested that using near-infrared fluorescence cholangiography during laparoscopic cholecystectomy markedly increases biliary anatomy visualization. The technology is rapidly evolving, and different equipment and doses may be used. We aimed to identify areas of consensus and nonconsensus in the use of incisionless near-infrared fluorescent cholangiography during laparoscopic cholecystectomy.METHODS: A 2-round Delphi survey was conducted among 28 international experts in minimally invasive surgery and near-infrared fluorescent cholangiography in 2020, during which respondents voted on 62 statements on patient preparation and contraindications (n = 12); on indocyanine green administration (n = 14); on potential advantages and uses of near-infrared fluorescent cholangiography (n = 18); comparing near-infrared fluorescent cholangiography with intraoperative x-ray cholangiography (n = 7); and on potential disadvantages of and required training for near-infrared fluorescent cholangiography (n = 11).RESULTS: Expert consensus strongly supports near-infrared fluorescent cholangiography superiority over white light for the visualization of biliary structures and reduction of laparoscopic cholecystectomy risks. It also offers other advantages like enhancing anatomic visualization in obese patients and those with moderate to severe inflammation. Regarding indocyanine green administration, consensus was reached that dosing should be on a milligrams/kilogram basis, rather than as an absolute dose, and that doses >0.05 mg/kg are necessary. Although there is no consensus on the optimum preoperative timing of indocyanine green injections, the majority of participants consider it important to administer indocyanine green at least 45 minutes before the procedure to decrease the light intensity of the liver.CONCLUSION: Near-infrared fluorescent cholangiography experts strongly agree on its effectiveness and safety during laparoscopic cholecystectomy and that it should be used routinely, but further research is necessary to establish optimum timing and doses for indocyanine green.",

keywords = "Humans, Indocyanine Green, Cholecystectomy, Laparoscopic/methods, Cholangiography/methods, Optical Imaging, Coloring Agents",

author = "Fernando Dip and Julio Aleman and Esther DeBoer and Luigi Boni and Michael Bouvet and Nicholas Buchs and Thomas Carus and Michele Diana and Elli, {Enrique F} and Merlijn Hutteman and Takeaki Ishizawa and Norihiro Kokudo and {Lo Menzo}, Emanuele and Kaja Ludwig and Edward Phillips and Regimbeau, {Jean Marc} and Homero Rodriguez-Zentner and Roy, {Mayank Dramani} and Sylke Schneider-Koriath and Schols, {Rutger M} and Danny Sherwinter and Conrad Simpfendorfer and Laurent Stassen and Samuel Szomstein and Alexander Vahrmeijer and Verbeek, {Floris P R} and Matthew Walsh and White, {Kevin P} and Rosenthal, {Raul J}",

year = "2022",

month = dec,

doi = "10.1016/j.surg.2022.07.012",

language = "English",

volume = "172",

pages = "S21--S28",

journal = "Surgery",

issn = "0039-6060",

publisher = "MOSBY-ELSEVIER",

number = "6",

}

Dip, F, Aleman, J, DeBoer, E, Boni, L, Bouvet, M, Buchs, N, Carus, T, Diana, M, Elli, EF, Hutteman, M, Ishizawa, T, Kokudo, N, Lo Menzo, E, Ludwig, K, Phillips, E, Regimbeau, JM, Rodriguez-Zentner, H, Roy, MD, Schneider-Koriath, S, Schols, RM, Sherwinter, D, Simpfendorfer, C, Stassen, L, Szomstein, S, Vahrmeijer, A, Verbeek, FPR, Walsh, M, White, KP & Rosenthal, RJ 2022, 'Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: Results of an international Delphi survey', Surgery, vol. 172, no. 6, pp. S21-S28. https://doi.org/10.1016/j.surg.2022.07.012

TY - JOUR

T1 - Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy

T2 - Results of an international Delphi survey

AU - Dip, Fernando

AU - Aleman, Julio

AU - DeBoer, Esther

AU - Boni, Luigi

AU - Bouvet, Michael

AU - Buchs, Nicholas

AU - Carus, Thomas

AU - Diana, Michele

AU - Elli, Enrique F

AU - Hutteman, Merlijn

AU - Ishizawa, Takeaki

AU - Kokudo, Norihiro

AU - Lo Menzo, Emanuele

AU - Ludwig, Kaja

AU - Phillips, Edward

AU - Regimbeau, Jean Marc

AU - Rodriguez-Zentner, Homero

AU - Roy, Mayank Dramani

AU - Schneider-Koriath, Sylke

AU - Schols, Rutger M

AU - Sherwinter, Danny

AU - Simpfendorfer, Conrad

AU - Stassen, Laurent

AU - Szomstein, Samuel

AU - Vahrmeijer, Alexander

AU - Verbeek, Floris P R

AU - Walsh, Matthew

AU - White, Kevin P

AU - Rosenthal, Raul J

PY - 2022/12

Y1 - 2022/12

N2 - BACKGROUND: Published empirical data have increasingly suggested that using near-infrared fluorescence cholangiography during laparoscopic cholecystectomy markedly increases biliary anatomy visualization. The technology is rapidly evolving, and different equipment and doses may be used. We aimed to identify areas of consensus and nonconsensus in the use of incisionless near-infrared fluorescent cholangiography during laparoscopic cholecystectomy.METHODS: A 2-round Delphi survey was conducted among 28 international experts in minimally invasive surgery and near-infrared fluorescent cholangiography in 2020, during which respondents voted on 62 statements on patient preparation and contraindications (n = 12); on indocyanine green administration (n = 14); on potential advantages and uses of near-infrared fluorescent cholangiography (n = 18); comparing near-infrared fluorescent cholangiography with intraoperative x-ray cholangiography (n = 7); and on potential disadvantages of and required training for near-infrared fluorescent cholangiography (n = 11).RESULTS: Expert consensus strongly supports near-infrared fluorescent cholangiography superiority over white light for the visualization of biliary structures and reduction of laparoscopic cholecystectomy risks. It also offers other advantages like enhancing anatomic visualization in obese patients and those with moderate to severe inflammation. Regarding indocyanine green administration, consensus was reached that dosing should be on a milligrams/kilogram basis, rather than as an absolute dose, and that doses >0.05 mg/kg are necessary. Although there is no consensus on the optimum preoperative timing of indocyanine green injections, the majority of participants consider it important to administer indocyanine green at least 45 minutes before the procedure to decrease the light intensity of the liver.CONCLUSION: Near-infrared fluorescent cholangiography experts strongly agree on its effectiveness and safety during laparoscopic cholecystectomy and that it should be used routinely, but further research is necessary to establish optimum timing and doses for indocyanine green.

AB - BACKGROUND: Published empirical data have increasingly suggested that using near-infrared fluorescence cholangiography during laparoscopic cholecystectomy markedly increases biliary anatomy visualization. The technology is rapidly evolving, and different equipment and doses may be used. We aimed to identify areas of consensus and nonconsensus in the use of incisionless near-infrared fluorescent cholangiography during laparoscopic cholecystectomy.METHODS: A 2-round Delphi survey was conducted among 28 international experts in minimally invasive surgery and near-infrared fluorescent cholangiography in 2020, during which respondents voted on 62 statements on patient preparation and contraindications (n = 12); on indocyanine green administration (n = 14); on potential advantages and uses of near-infrared fluorescent cholangiography (n = 18); comparing near-infrared fluorescent cholangiography with intraoperative x-ray cholangiography (n = 7); and on potential disadvantages of and required training for near-infrared fluorescent cholangiography (n = 11).RESULTS: Expert consensus strongly supports near-infrared fluorescent cholangiography superiority over white light for the visualization of biliary structures and reduction of laparoscopic cholecystectomy risks. It also offers other advantages like enhancing anatomic visualization in obese patients and those with moderate to severe inflammation. Regarding indocyanine green administration, consensus was reached that dosing should be on a milligrams/kilogram basis, rather than as an absolute dose, and that doses >0.05 mg/kg are necessary. Although there is no consensus on the optimum preoperative timing of indocyanine green injections, the majority of participants consider it important to administer indocyanine green at least 45 minutes before the procedure to decrease the light intensity of the liver.CONCLUSION: Near-infrared fluorescent cholangiography experts strongly agree on its effectiveness and safety during laparoscopic cholecystectomy and that it should be used routinely, but further research is necessary to establish optimum timing and doses for indocyanine green.

KW - Humans

KW - Indocyanine Green

KW - Cholecystectomy, Laparoscopic/methods

KW - Cholangiography/methods

KW - Optical Imaging

KW - Coloring Agents

U2 - 10.1016/j.surg.2022.07.012

DO - 10.1016/j.surg.2022.07.012

M3 - Article

C2 - 36427926

SN - 0039-6060

VL - 172

SP - S21-S28

JO - Surgery

JF - Surgery

IS - 6

ER -