Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
Surg Technol Int. 2021 May 20;38:98-101. doi: 10.52198/21.STI.38.GS1388.
Surgery involving the biliary tree is common but has the potential for serious complications. Adjuncts such as intraoperative cholangiogram and, more recently, indocyanine green (ICG) fluorescence cholangiography, have been used to more accurately define the relevant anatomy and decrease the risk of common bile duct injury. The optimal ICG dose is unknown, but the most commonly cited dose in the literature is 2.5 mg. We describe our experience using micro-dosing of ICG as proof-of-concept for its successful use in the identification of biliary structures.
A video library from a variety of hepatobiliary surgeries which included micro-dosing of ICG was compiled between 2018 and 2020. These videos were retrospectively reviewed and graded for the degree of visualization of biliary structures (complete, partial, none) and the degree of background liver fluorescence (significant, moderate, minimal).
Overall, 40 videos were reviewed; 70% were minimally invasive cholecystectomies. Micro-dosing was used in all patients; complete visualization was achieved in 52.5% of the patients, partial visualization in 40%, and no visualization in 7.6%. Eighty percent of patients had minimal to moderate background fluorescence. Despite ICG micro-dosing, 20% of the patients still had significant liver dye uptake.
ICG cholangiography is an alternative to more invasive means of intraoperative imaging during biliary surgery, but the optimal dose of ICG is unknown. We have used a 0.05 mg micro-dose of ICG to successfully visualize biliary structures and reduce background liver fluorescence. This preliminary report can be used to develop further studies into whether micro-dosing of ICG is associated with improved clinical outcomes.
胆道手术较为常见，但存在严重并发症的风险。术中胆管造影术等辅助手段，以及最近的吲哚菁绿（ICG）荧光胆管造影术，已被用于更准确地定义相关解剖结构，降低胆总管损伤的风险。但最佳 ICG 剂量尚不清楚，而文献中最常引用的剂量是 2.5mg。我们描述了使用 ICG 微剂量的经验，以此证明其在识别胆管结构方面的成功应用。
我们于 2018 年至 2020 年期间编译了一个包含 ICG 微剂量的各种肝胆手术视频库。这些视频被回顾性地进行了回顾和分级，以评估胆管结构的可视化程度（完全、部分、无）和背景肝脏荧光程度（显著、中度、轻微）。
总体上，我们回顾了 40 个视频；70%为微创胆囊切除术。所有患者均使用微剂量；52.5%的患者完全可视化，40%的患者部分可视化，7.6%的患者无可视化。80%的患者背景荧光为轻度至中度。尽管使用了 ICG 微剂量，但仍有 20%的患者存在明显的肝脏染料摄取。
ICG 胆管造影术是胆道手术中替代更具侵袭性的术中成像手段的方法，但 ICG 的最佳剂量尚不清楚。我们使用了 0.05mg 的 ICG 微剂量，成功地可视化了胆管结构并降低了背景肝脏荧光。这一初步报告可用于进一步研究 ICG 微剂量是否与改善临床结果相关。
