72243 - Indocyanine Green Fluorescence During Fundus First Laparoscopic Cholecystectomy

Introduction

Our objective was to compare Fundus First (FF) laparoscopic cholecystectomies (LC) before and after the implementation of routine use of Indocyanine green (ICG) fluorescence.

Bile duct injury (BDI) is a rare but serious complication during LC. ICG fluorescence visualizes the bile ducts and may reduce the risk of BDI. Previous studies have compared ICG with conventional visualization and shown reduced operative times and conversion rates. This study retrospectively compared LC with and without ICG fluorescence in a Swedish hospital routinely practicing the FF method.

Method

Pre-, intra- and postoperative data from patients operated at Sundsvall County Hospital before and after the implementation of routine use of ICG fluorescence between 2016 and 2023 was analyzed.

Result

Altogether 2009 patients underwent LC. FF was used in 94.9% of all operations, 1455 with ICG and 549 without, respectively. The groups were comparable regarding gender, BMI, age, presence of acute cholecystitis and distribution urgent/elective surgeries. Implementation was safe with similar 30-day complication rates between study groups. A lower conversion rate with ICG was found (1.2% vs 3.3%, p=0.001) as was a non-significant reduction in readmissions (p=0.054). No significant difference in BDI was seen.

ICG was associated with prolonged operative times in univariate analysis, but the association disappeared in multivariable analysis. The time to cholangiography was prolonged in the ICG-group, both in univariate and multivariate analyses.

Discussion

Implementation of ICG fluorescence was safe and efficient, suggesting possible safety improvements for a Fundus First LC. Further studies are needed to evaluate if ICG provides additional safety in LC.