Indocyanine green fluorescence intraoperative cholangiography during laparoscopic cholecystectomy: comparative analysis of the doses

Abstract

Introduction: Since 2020, the effectiveness and superiority of intraoperative cholangiography with indocyanine green has been demonstrated. However, to date there is no consensus on the optimal dose of indocyanine green to be administered that allows the greatest enhancement of the extrahepatic biliary tract with less enhancement of the hepatic parenchyma. The main objective of this project is to analyze the differences between a weight-adjusted dose of indocyanine green of 0.0119mg/kg and a dose of 2.5mg administered one hour before surgery in patients undergoing laparoscopic cholecystectomy at the Trinidad Teaching Medical Center between April - November 2023. Methods: randomized clinical trial. Thirty patients were evaluated and divided into two groups according to the dose administered. General and demographic data were obtained; from the surgical procedure the fluorescence intensity of the biliary tract was evaluated. After surgery, the data collection instrument was filled out and copied into a database to be analyzed a posteriori. Results: There were no adverse reactions to drug administration, nor trans or postoperative complications. With the micro dose the cystic duct was identified in 42% and 82% before and after dissection of the Calot's triangle, while with the standard dose 30% and 93%, these differences were not significant, however, a general tendency of superiority of the micro dose is appreciated. In patients with obesity the percentage of cystic duct identification with micro dose and standard was 0% and 33% p<0.5. Conclusion: Micro dose seems to have the same performance as standard dose, except in obese.