![]() The first part included patients with T tubes for more than 1 month. After the patient was injected with ICG, bile was collected at 10 time points to explore the change and trends of bile fluorescence intensity (FI). In addition, the results of the first experiment were used to setup a randomized controlled trial (RCT) that aimed to find the optimal dosing timing for ICG injections for laparoscopic cholecystectomy (LC). ResultsĪfter performing a systematic review, the ICG injection dose for each patient in the clinical trial was 10 mg.ĭuring surgery, imaging data were collected for analysis. ![]() Five patients were included in the first part of the study. Bile collected 8 h after ICG injection had a higher FI than bile collected at other time points ( p < 0.05), and the FI of bile collected 20 h after ICG injection was nearly zero. In the second part of the experiment, 4 groups of patients (6 patients per group) were injected with 10 mg ICG at 8, 10, 12 and 14 h prior to surgery. The distribution of bile duct FI ( p = 0.001), liver FI ( p < 0.001), and common bile duct (CBD)-to-liver contrast ( p = 0.001) were not the same in each group. Further analysis with the Bonferroni method revealed the following: (1) the FI of the CBD in the 8 h group was significantly different from that in the 14 h group (adjusted p < 0.001) (2) the liver FI of the 8 h group was higher than that of the 10 h group (adjusted p = 0.042) and the 14 h group (adjusted p < 0.001) and (3) the CBD-to-liver contrast of the 8 h group was lower than that of the 10 h group (adjusted p = 0.013) and the 14 h group (adjusted p = 0.001). ![]() ICG FC enables the real-time identification of extrahepatic bile ducts. The optimal effect of FC can be achieved by performing 10 mg ICG injections 10 to 12 h prior to surgery. There is no doubt that high-quality fluorescence imaging can help surgeons identify the anatomy of the extrahepatic biliary tract. The dose and dosing time of ICG are key factors that affect the performance of high-quality fluorescence imaging because if fluorescence imaging is performed directly after the administration of ICG, the liver will be highly fluorescent while bile ducts will not yet contain enough ICG (Fig. In contrast, if fluorescence imaging is performed too long after the administration of ICG, the fluorescence intensity (FI) of the common bile duct (CBD) and liver will be so low that it cannot be conducive to identifying anatomical structures (Fig. The optimal signal would involve a high fluorescence signal in bile ducts and a low fluorescence signal from the liver tissue in the background (Fig. However, among the published studies, the dosage and timing of ICG administration widely varied for instance, various studies used 2.5 mg administered within 0.5 h or 1 h prior to surgery, 12.5 mg administered within 0.5 h prior to surgery, and 0.05 mg/kg administered within 1 h prior to surgery. However, only a few studies have tried to optimize the dose and timing of administration.
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