Fluorescent Cholangiogram—Optimal Dose and Timing

Background: A bile duct injury (BDI) is a serious complication of laparoscopic cholecystectomy (LC).In the United States the reported incidence is about 0.2%, with approximately 750,000 LCs performed annually.Fluorescent cholangiogram (FC) with indocyanine green (ICG) is a novel technique aimed at reducing the incidence of BDI.Still, there are differences regarding the optimal doze and timing of ICG administration prior to LC.Methods: We performed FC with 3 different doses of ICG (0.05 mg/kg, 1 and 2 mg) injected at 3 different time intervals prior to LC (1, 3, and 6 hours) for a total of 9 different visualizations.Images of the visualized of bile tree anatomy were obtained under white light and near infrared light (NIR) for all cases.A survey questionnaire was prepared and sent out to practitioners via Google Form.Results: A total of 122 people completed the survey.Most of them preferred visualization with 1-mg ICG injected 3 hours preoperatively.Only 16% of practitioners reported routine use of FC, however 87% found the method useful.When asked if they were willing to use the method routinely, specialists were significantly more likely to respond with "No" (x 2 5 4.438, df 5 1, P 5 .035,f 5 À0.191).Conclusion: FC is a useful technique that is still not widely adopted, but has a high level of appreciation for its usefulness.