Abstract
BackgroundRecently, we reported the feasibility of indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging to identify extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC) in pediatric patients. This paper aimed to describe the use of a new technology, RUBINA™, to perform intra-operative ICG fluorescent cholangiography (FC) in pediatric LC.MethodsDuring the last year, ICG-FC was performed during LC using the new technology RUBINA™ in two pediatric surgery units. The ICG dosage was 0.35 mg/Kg and the median timing of administration was 15.6 h prior to surgery. Patient baseline, intra-operative details, rate of biliary anatomy identification, utilization ease, and surgical outcomes were assessed.ResultsThirteen patients (11 girls), with median age at surgery of 12.9 years, underwent LC using the new RUBINA™ technology. Six patients (46.1%) had associated comorbidities and five (38.5%) were practicing drug therapy. Pre-operative workup included ultrasound (n = 13) and cholangio-MRI (n = 5), excluding biliary and/or vascular anatomical anomalies. One patient needed conversion to open surgery and was excluded from the study. The median operative time was 96.9 min (range 55–180). Technical failure of intra-operative ICG-NIRF visualization occurred in 2/12 patients (16.7%). In the other cases, ICG-NIRF allowed to identify biliary/vascular anatomic anomalies in 4/12 (33.3%), including Moynihan's hump of the right hepatic artery (n = 1), supravescicular bile duct (n = 1), and short cystic duct (n = 2). No allergic or adverse reactions to ICG, post-operative complications, or reoperations were reported.ConclusionOur preliminary experience suggested that the new RUBINA™ technology was very effective to perform ICG-FC during LC in pediatric patients. The advantages of this technology include the possibility to overlay the ICG-NIRF data onto the standard white light image and provide surgeons a constant fluorescence imaging of the target anatomy to assess position of critical biliary structures or presence of anatomical anomalies and safely perform the operation.
Highlights
We reported the feasibility of indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging to identify extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC) in pediatric patients
We reported the feasibility of ICG near-infrared fluorescence (NIRF) imaging to obtain detailed anatomical mapping of extrahepatic biliary structures during LC in the pediatric population as well [17,18,19]
This paper aimed to describe the use of a new technology, RUBINATM, to perform intra-operative ICG-fluorescent cholangiography (FC) during pediatric LC
Summary
Patients undergoing LC at two divisions of Pediatric Surgery from January 2020 to January 2021, received intraoperatively ICG-FC using the new technology RUBINATM. After trocar placement and induction of pneumoperitoneum, the ICG-NIRF was activated by pushing a button on the camera head and allowed real-time fluorescent visualization of extrahepatic biliary structures before dissection of the Calot’s triangle. The RUBINATM components offer various new modes for visualizing the ICG-NIRF signal. The ICG-NIRF data are overlapped onto the standard white light image to generate an overlay image (Fig. 1a). The ICG-NIRF signal alone is displayed in white on a black background to achieve the greatest possible differentiation (Fig. 1b). The intensity map mode displays the intensity of the ICG-NIRF signal using a color scale in an overlay image (Fig. 1c). Intra-operative details, rate of biliary anatomy identification, utilization ease, and surgical outcomes were assessed
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