Graves Claire, Ely Sora, Idowu Olajire, Newton Christopher, Kim Sunghoon
Division of Pediatric Surgery, UCSF Benioff Children's Hospitals , Oakland and San Francisco, California.
J Laparoendosc Adv Surg Tech A. 2017 Oct;27(10):1069-1073. doi: 10.1089/lap.2017.0070. Epub 2017 Jun 2.
Intravenous injection of indocyanine green (ICG) is used to illuminate extrahepatic biliary anatomy. Fluorescence of biliary structures may lower surgical complications that can arise due to inadvertent injury to the common bile duct. We describe a method of injecting ICG directly into the gallbladder to define the cystic duct and common bile duct anatomy.
A standard laparoscopic cholecystectomy was performed using a laparoscope with near-infrared imaging capability. Before dissection, the gallbladder was punctured with a cholangiogram catheter or a pigtail catheter to aspirate the bile within the gallbladder. The aspirated bile is mixed with ICG solution, which is reinjected into the gallbladder to fluoresce the gallbladder, cystic duct, and common bile duct structures.
Eleven patients underwent direct gallbladder ICG injection for fluorescence cholangiography during cholecystectomy. Direct gallbladder ICG injection clearly defined the extrahepatic biliary anatomy, including the cystic duct-common bile duct junction, by fluorescence. In addition, the dissection plane between the gallbladder and the liver is highlighted with the gallbladder ICG fluorescence.
Direct gallbladder ICG injection provides immediate visualization of extrahepatic biliary structures and clarifies the dissection plane between the gallbladder and the liver bed.
静脉注射吲哚菁绿（ICG）用于照亮肝外胆道解剖结构。胆道结构的荧光可能会降低因意外损伤胆总管而引起的手术并发症。我们描述了一种将ICG直接注入胆囊以明确胆囊管和胆总管解剖结构的方法。
使用具有近红外成像能力的腹腔镜进行标准的腹腔镜胆囊切除术。在解剖之前，用胆管造影导管或猪尾导管穿刺胆囊以抽吸胆囊内的胆汁。将吸出的胆汁与ICG溶液混合，然后重新注入胆囊以使胆囊、胆囊管和胆总管结构发出荧光。
11例患者在胆囊切除术中接受了直接胆囊ICG注射用于荧光胆管造影。直接胆囊ICG注射通过荧光清晰地界定了肝外胆道解剖结构，包括胆囊管-胆总管交界处。此外，胆囊ICG荧光突出了胆囊与肝脏之间的解剖平面。
直接胆囊ICG注射可立即显示肝外胆道结构，并明确胆囊与肝床之间的解剖平面。
