Indocyanine green fluorescent cholangiography and intraoperative angiography with laparoscopic cholecystectomy: a randomized controlled trial

IntroductionLaparoscopic cholecystectomy (LC) is the standard of care in the management of a diseased gall bladder. Sometimes it is complicated by bile duct injury, a significant cause of morbidity and mortality. Efforts are continuous to develop a standard technique to do it safely. Indocyanine green (ICG), fluorescent cholangiography was proposed to serve this cause.Patients and methodsA double-blinded, randomized, controlled trial involved patients who underwent LC in Ain-Shams University Specialized Hospital from January 2020 till July 2021. Group A (n=60) underwent LC using the usual white light; group B (n=58) underwent LC with ICG florescence cholangiography and intraoperative ICG florescence arteriography.ResultsFemales represented 78%, the mean age was 42.4 years, and the median BMI was 35.5. ICG was injected at a median time of 6.5 h before surgery. The blood loss was comparable between the two groups. In group B, all three structures were clearly identified in nearly all the patients. The common hepatic duct identification rate was 96.5% (P<0.001), cystic duct 98.2% (P=0.0175), and common bile duct was 94.8% (P<0.001). The operative time was significantly shorter in group B (P<0.001). None of the cases were converted to open and no biliary tree injuries were recorded in both groups and none of the patients injected or reinjected with the ICG experienced any symptoms or signs of allergy or reaction.ConclusionThe near-infrared//(ICG cholangiography is an easy, safe, and effective technique to identify the extrahepatic biliary ducts, we recommend its routine use.