TY - JOUR
T1 - Fluorescence-based cholangiography
T2 - preliminary results from the IHU-IRCAD-EAES EURO-FIGS registry
AU - Agnus, Vincent
AU - Pesce, Antonio
AU - Boni, Luigi
AU - Van Den Bos, Jacqueline
AU - Morales-Conde, Salvador
AU - Paganini, Alessandro M.
AU - Quaresima, Silvia
AU - Balla, Andrea
AU - La Greca, Gaetano
AU - Plaudis, Haralds
AU - Moretto, Gianluigi
AU - Castagnola, Maurizio
AU - Santi, Caterina
AU - Casali, Lorenzo
AU - Tartamella, Luciano
AU - Saadi, Alend
AU - Picchetto, Andrea
AU - Arezzo, Alberto
AU - Marescaux, Jacques
AU - Diana, Michele
N1 - Funding Information:
The EURO-FIGS registry is funded by a grant from the ARC Foundation for Cancer Research (9, rue Guy Môquet; 94803 Villejuif Cedex, France, www.fondation-arc.org ), within the framework of the ELIOS (Endoscopic Luminescent Imaging for precision Oncologic Surgery) project.
Funding Information:
Michele Diana is PI and the recipient of the ELIOS grant. Jacques Marescaux is President of both the IRCAD and IHU Institutes, which are partly funded by KARL STORZ, Medtronic, and Siemens Healthcare. Luigi Boni reports consulting position with various companies outside the submitted work. Vincent Agnus, Antonio Pesce, Jacqueline Van Den Bos, Salvador Morales-Conde, Alessandro Paganini, Silvia Quaresima, Andrea Balla, Gaetano La Greca, Haralds Plaudis, Gianluigi Moretto, Maurizio Castagnola, Caterina Santi, Lorenzo Casali, Luciano Tartamella, Alend Saadi, Andrea Picchetto, Alberto Arezzo have no conflicts of interest or financial ties to disclose.
Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - 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.
AB - 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.
KW - Fluorescence-guided surgery
KW - Image-guided surgery
KW - Near-infrared fluorescence cholangiography
KW - Registry
UR - http://www.scopus.com/inward/record.url?scp=85073965329&partnerID=8YFLogxK
U2 - 10.1007/s00464-019-07157-3
DO - 10.1007/s00464-019-07157-3
M3 - Article
C2 - 31591654
AN - SCOPUS:85073965329
SN - 0930-2794
VL - 34
SP - 3888
EP - 3896
JO - Surgical Endoscopy
JF - Surgical Endoscopy
IS - 9
ER -