Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Division of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy.
Surg Endosc. 2021 Nov;35(11):6366-6373. doi: 10.1007/s00464-021-08596-7. Epub 2021 Jul 6.
Recently, we reported the feasibility of indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging to identify extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC) in pediatric patients. This paper aimed to describe the use of a new technology, RUBINA™, to perform intra-operative ICG fluorescent cholangiography (FC) in pediatric LC.
During the last year, ICG-FC was performed during LC using the new technology RUBINA™ in two pediatric surgery units. The ICG dosage was 0.35 mg/Kg and the median timing of administration was 15.6 h prior to surgery. Patient baseline, intra-operative details, rate of biliary anatomy identification, utilization ease, and surgical outcomes were assessed.
Thirteen patients (11 girls), with median age at surgery of 12.9 years, underwent LC using the new RUBINA™ technology. Six patients (46.1%) had associated comorbidities and five (38.5%) were practicing drug therapy. Pre-operative workup included ultrasound (n = 13) and cholangio-MRI (n = 5), excluding biliary and/or vascular anatomical anomalies. One patient needed conversion to open surgery and was excluded from the study. The median operative time was 96.9 min (range 55-180). Technical failure of intra-operative ICG-NIRF visualization occurred in 2/12 patients (16.7%). In the other cases, ICG-NIRF allowed to identify biliary/vascular anatomic anomalies in 4/12 (33.3%), including Moynihan's hump of the right hepatic artery (n = 1), supravescicular bile duct (n = 1), and short cystic duct (n = 2). No allergic or adverse reactions to ICG, post-operative complications, or reoperations were reported.
Our preliminary experience suggested that the new RUBINA™ technology was very effective to perform ICG-FC during LC in pediatric patients. The advantages of this technology include the possibility to overlay the ICG-NIRF data onto the standard white light image and provide surgeons a constant fluorescence imaging of the target anatomy to assess position of critical biliary structures or presence of anatomical anomalies and safely perform the operation.
最近，我们报道了吲哚菁绿（ICG）近红外荧光（NIRF）成像用于识别腹腔镜胆囊切除术（LC）中肝外胆道解剖结构的可行性。本文旨在描述一种新技术 RUBINA™ 在小儿 LC 中进行术中吲哚菁绿荧光胆管造影（FC）的应用。
在过去的一年中，在两个小儿外科单位中使用新技术 RUBINA™ 在 LC 中进行 ICG-FC。ICG 剂量为 0.35mg/Kg，给药时间中位数为手术前 15.6 小时。评估了患者的基线、术中细节、胆道解剖结构识别率、使用便利性和手术结果。
13 名（11 名女性）手术年龄中位数为 12.9 岁的患者使用新的 RUBINA™ 技术进行了 LC。6 名患者（46.1%）存在合并症，5 名患者（38.5%）正在接受药物治疗。术前检查包括超声（n=13）和胆管 MRI（n=5），排除了胆道和/或血管解剖异常。1 名患者需要转为开放手术，因此被排除在研究之外。中位手术时间为 96.9 分钟（范围 55-180 分钟）。术中 ICG-NIRF 可视化技术失败发生在 2/12 例患者（16.7%）。在其他情况下，ICG-NIRF 可以识别胆道/血管解剖异常，在 12 例患者中有 4 例（33.3%），包括右肝动脉的莫尼汉驼峰（n=1）、肝上胆管（n=1）和短胆囊管（n=2）。未报告对 ICG 的过敏或不良反应、术后并发症或再次手术。
我们的初步经验表明，新技术 RUBINA™ 非常有效地在小儿患者的 LC 中进行 ICG-FC。该技术的优点包括能够将 ICG-NIRF 数据叠加到标准白光图像上，并为外科医生提供目标解剖结构的恒定荧光成像，以评估关键胆道结构的位置或存在解剖异常，并安全地进行手术。
