Vincent Agnus1, Antonio Pesce2, Luigi Boni3, Jacqueline Van Den Bos4, Salvador Morales-Conde5, Alessandro M Paganini6, Silvia Quaresima6, Andrea Balla6, Gaetano La Greca2, Haralds Plaudis7, Gianluigi Moretto8, Maurizio Castagnola9, Caterina Santi10, Lorenzo Casali10, Luciano Tartamella10, Alend Saadi11, Andrea Picchetto12, Alberto Arezzo13, Jacques Marescaux1,14, Michele Diana15,16,17. 1. IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. 2. Department of Medical Surgical Sciences and Advanced Technologies "Ingrassia", Cannizzaro Hospital, University of Catania, Catania, Italy. 3. Department of Surgery, IRCCS - Ca' Granda - University Hospital of Milan, Milan, Italy. 4. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. 5. Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain. 6. Obesity and Minimally Invasive Surgery Division, Department of Cardiothoracic, Vascular Surgery, and Organ Transplantation, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy. 7. Department of General and Emergency Surgery, Riga East Clinical University Hospital "Gailezers", Riga, Latvia. 8. Department of General Surgery, Ospedale Pederzoli, Peschiera del Garda, Verona, Italy. 9. Ente Ospedaliero Ospedali Galliera, Genoa, Italy. 10. Azienda Unità Sanitaria Locale di Parma, Ospedale di Fidenza, Parma, Italy. 11. Department of General Surgery, Hospital of Pourtalès, Neuchâtel, Switzerland. 12. General and Colorectal Surgery Division, Department of Cardiothoracic, Vascular Surgery and Organ Transplantation, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy. 13. Department of Surgical Sciences, University of Torino, Turin, Italy. 14. IRCAD, Research Institute Against Cancer of the Digestive System, 1, Place de l'Hôpital, 67091, Strasbourg, France. 15. IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. michele.diana@ircad.fr. 16. Department of General Surgery, Hospital of Pourtalès, Neuchâtel, Switzerland. michele.diana@ircad.fr. 17. IRCAD, Research Institute Against Cancer of the Digestive System, 1, Place de l'Hôpital, 67091, Strasbourg, France. michele.diana@ircad.fr.
Abstract
INTRODUCTION: Near-infrared fluorescence cholangiography (NIRF-C) is a popular application of fluorescence image-guided surgery (FIGS). NIRF-C requires near-infrared optimized laparoscopes and the injection of a fluorophore, most frequently Indocyanine Green (ICG), to highlight the biliary anatomy. It is investigated as a tool to increase safety during cholecystectomy. The European registry on FIGS (EURO-FIGS: www.euro-figs.eu ) aims to obtain a snapshot of the current practices of FIGS across Europe. Data on NIRF-C are presented. METHODS: EURO-FIGS is a secured online database which collects anonymized data on surgical procedures performed using FIGS. Data collected for NIRF-C include gender, age, Body Mass Index (BMI), pathology, NIR device, ICG dose, ICG timing of administration before intraoperative visualization, visualization (Y/N) of biliary structures such as the cystic duct (CD), the common bile duct (CBD), the CD-CBD junction, the common hepatic duct (CHD), Visualization scores, adverse reactions to ICG, operative time, and surgical complications. RESULTS: Fifteen surgeons (12 European surgical centers) uploaded 314 cases of NIRF-C during cholecystectomy (cholelithiasis n = 249, cholecystitis n = 58, polyps n = 7), using 4 different NIR devices. ICG doses (mg/kg) varied largely (mean 0.28 ± 0.17, median 0.3, range: 0.02-0.62). Similarly, injection-to-visualization timing (minutes) varied largely (mean 217 ± 357; median 57), ranging from 1 min (direct intragallbladder injection in 2 cases) to 3120 min (n = 2 cases). Visualization scores before dissection were significantly correlated, at univariate analysis, with ICG timing (all structures), ICG dose (CD-CBD), device (CD and CD-CBD), surgeon (CD and CD-CBD), and pathology (CD and CD-CBD). BMI was not correlated. At multivariate analysis, pathology and timing remained significant factors affecting the visualization scores of all three structures, whereas ICG dose remained correlated with HD visualization only. CONCLUSIONS: The EURO-FIGS registry has confirmed a wide disparity in ICG dose and timing in NIRF-C. EURO-FIGS can represent a valuable tool to promote and monitor FIGS-related educational and consensus activities in Europe.
INTRODUCTION: Near-infrared fluorescence cholangiography (NIRF-C) is a popular application of fluorescence image-guided surgery (FIGS). NIRF-C requires near-infrared optimized laparoscopes and the injection of a fluorophore, most frequently Indocyanine Green (ICG), to highlight the biliary anatomy. It is investigated as a tool to increase safety during cholecystectomy. The European registry on FIGS (EURO-FIGS: www.euro-figs.eu ) aims to obtain a snapshot of the current practices of FIGS across Europe. Data on NIRF-C are presented. METHODS:EURO-FIGS is a secured online database which collects anonymized data on surgical procedures performed using FIGS. Data collected for NIRF-C include gender, age, Body Mass Index (BMI), pathology, NIR device, ICG dose, ICG timing of administration before intraoperative visualization, visualization (Y/N) of biliary structures such as the cystic duct (CD), the common bile duct (CBD), the CD-CBD junction, the common hepatic duct (CHD), Visualization scores, adverse reactions to ICG, operative time, and surgical complications. RESULTS: Fifteen surgeons (12 European surgical centers) uploaded 314 cases of NIRF-C during cholecystectomy (cholelithiasis n = 249, cholecystitis n = 58, polyps n = 7), using 4 different NIR devices. ICG doses (mg/kg) varied largely (mean 0.28 ± 0.17, median 0.3, range: 0.02-0.62). Similarly, injection-to-visualization timing (minutes) varied largely (mean 217 ± 357; median 57), ranging from 1 min (direct intragallbladder injection in 2 cases) to 3120 min (n = 2 cases). Visualization scores before dissection were significantly correlated, at univariate analysis, with ICG timing (all structures), ICG dose (CD-CBD), device (CD and CD-CBD), surgeon (CD and CD-CBD), and pathology (CD and CD-CBD). BMI was not correlated. At multivariate analysis, pathology and timing remained significant factors affecting the visualization scores of all three structures, whereas ICG dose remained correlated with HD visualization only. CONCLUSIONS: The EURO-FIGS registry has confirmed a wide disparity in ICG dose and timing in NIRF-C. EURO-FIGS can represent a valuable tool to promote and monitor FIGS-related educational and consensus activities in Europe.
Authors: Dragos Serban; Dumitru Cristinel Badiu; Dragos Davitoiu; Ciprian Tanasescu; Mihail Silviu Tudosie; Alexandru Dan Sabau; Ana Maria Dascalu; Corneliu Tudor; Simona Andreea Balasescu; Bogdan Socea; Daniel Ovidiu Costea; Anca Zgura; Andreea Cristina Costea; Laura Carina Tribus; Catalin Gabriel Smarandache Journal: Exp Ther Med Date: 2021-12-30 Impact factor: 2.447
Authors: Rabi R Datta; Sebastian Schönhage; Thomas Dratsch; Justus Toader; Dolores T Müller; Roger Wahba; Robert Kleinert; Michael Thomas; Georg Dieplinger; Dirk L Stippel; Christiane J Bruns; Hans F Fuchs Journal: Surg Endosc Date: 2020-09-23 Impact factor: 4.584