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, 31 (7), 2731-2742

Biliary Tract Visualization Using Near-Infrared Imaging With Indocyanine Green During Laparoscopic Cholecystectomy: Results of a Systematic Review


Biliary Tract Visualization Using Near-Infrared Imaging With Indocyanine Green During Laparoscopic Cholecystectomy: Results of a Systematic Review

S L Vlek et al. Surg Endosc.


Background: Near-infrared imaging with indocyanine green (ICG) has been extensively investigated during laparoscopic cholecystectomy (LC). However, methods vary between studies, especially regarding patient selection, dosage and timing. The aim of this systematic review was to evaluate the potential of the near-infrared imaging technique with ICG to identify biliary structures during LC.

Methods: A comprehensive systematic literature search was performed. Prospective trials examining the use of ICG during LC were included. Primary outcome was biliary tract visualization. Risk of bias was assessed using ROBINS-I. Secondly, a meta-analysis was performed comparing ICG to intraoperative cholangiography (IOC) for identification of biliary structures. GRADE was used to assess the quality of the evidence.

Results: Nineteen studies were included. Based upon the pooled data from 13 studies, cystic duct (Lusch et al. in J Endourol 28:261-266, 2014) visualization was 86.5% (95% CI 71.2-96.6%) prior to dissection of Calot's triangle with a 2.5-mg dosage of ICG and 96.5% (95% CI 93.9-98.4%) after dissection. The results were not appreciably different when the dosage was based upon bodyweight. There is moderate quality evidence that the CD is more frequently visualized using ICG than IOC (RR 1.16; 95% CI 1.00-1.35); however, this difference was not statistically significant.

Conclusion: This systematic review provides equal results for biliary tract visualization with near-infrared imaging with ICG during LC compared to IOC. Near-infrared imaging with ICG has the potential to replace IOC for biliary mapping. However, methods of near-infrared imaging with ICG vary. Future research is necessary for optimization and standardization of the near-infrared ICG technique.

Keywords: Biliary tract visualization; ICG; Intraoperative cholangiography; Laparoscopic cholecystectomy; Near-infrared imaging.

Conflict of interest statement

S. Vlek, D. van Dam, S. Rubinstein, E. de Lange-de Klerk, L. Schoonmade, J. Tuynman, J. Meijerink and M. Ankersmit have no conflicts of interest or financial ties to disclose.


Fig. 1
Fig. 1
PRISMA—flowchart of search strategy (8 February 2016)
Fig. 2
Fig. 2
A Meta-analysis of CD visualization. ICG versus IOC. B Meta-analysis of CBD visualization. ICG versus IOC. C Meta-analysis of CHD visualization. ICG versus IOC

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