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In the April issue of Archives, Ishizawa et al1 reported on the clinical use of indocyanine green (ICG) fluorescent cholangiography in a case of laparoscopic cholecystectomy (LC). A 2.5-mg intravenous dose of ICG given 2 hours before surgery defined the biliary anatomy by fluorescent imaging.
The laparoscopic fluorescent intraoperative ICG cholangiography proved safe and efficient in identifying the cystic and common hepatic ducts within the hepatoduodenal ligament. Although the experience is limited to a single case, Ishizawa et al are justified in emphasizing the merits of uninterrupted cholangiographic imaging, avoidance of ionizing radiation, and potential bile duct injury (BDI) during transcystic insertion of the cholangio catheter.
We described our experimental and clinical experience with color cholangiography using a 1.0-mg/kg intravenous injection of ICG 20 to 30 minutes before cholecystectomy.2 Our investigation was approved by our institutional review board and the Food and Drug Administration. Cholecystectomy in 20 pigs (laparoscopic and open) and 18 patients (laparoscopic only) yielded encouraging preliminary results on the efficacy and safety of the intravenous biliary dye. Indocyanine green is a nontoxic, anionic biliary dye that is taken up and excreted by the liver in unconjugated form. The extrahepatic bile duct and cystic duct become visibly dark blue 20 to 30 minutes after intravenous injection of ICG and remain stained for about 2 hours. A transient, statistically insignificant increase in bile duct pressure and caliber, most likely due to dye-induced choleresis, was observed. We fully agree with Ishizawa et al on the merits of nonradiographic, ICG-based cholangiography.
Correspondence: Dr Pertsemlidis, Department of Surgery, Mount Sinai School of Medicine, 1199 Park Ave, New York, NY 10128 (firstname.lastname@example.org).
Financial Disclosure: None reported.
Pertsemlidis D. Fluorescent Indocyanine Green for Imaging of Bile Ducts During Laparoscopic Cholecystectomy. Arch Surg. 2009;144(10):977–980. doi:10.1001/archsurg.2009.179
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