Evaluation of indocyanine green-enhanced fluorescence in hepatobiliary conditions in pediatric surgery

Emam, Mohamed S.; Youssef, Ahmed A.; Amra, Hazem S.; Abd-erRazik, Mohammad A.; Radwan, Ahmed B.; Youssef, Tarek; El Naggar, Osama

doi:10.4103/ejs.ejs_52_23

Evaluation of indocyanine green-enhanced fluorescence in hepatobiliary conditions in pediatric surgery

Authors

Abstract

Background
Indocyanine green (ICG) is a water-soluble tricarbocyanine dye developed by Kodak Research Laboratories for near-infrared photography in 1955. It was first approved by the Food and Drug Administration in 1956 to study hepatic and cardiac functions in humans. ICG is excited when illuminated by near-infrared light with a wavelength of 778–806 nm. The fluorescence emission is maximal at a wavelength of 832 nm and can penetrate tissue up to 15 mm. This emitted light is then captured with a special camera to be transformed and displayed as visible light.
Aim
This study aimed to evaluate the true extent of ICG application in pediatric patients, whether it is complementary to or replacement of traditional methods and its usefulness in visualizing a anatomy of a biliary system and vascular territory in various organs regarding intraoperative time, postoperative hospital stay and complications at Ain Shams University, Department of Pediatric Surgery.
Patients and methods
A case series was conducted on children with hepatobiliary diseases who were admitted to the Department of Pediatric Surgery of Ain Shams University hospitals. All patients were operated on by ICG-enhanced fluorescence-guided surgery.
Results
In the laparoscopic cholecystectomy group; common bile duct was evident in 75.0% of patients, and cystic duct and common hepatic duct were evident in all patients with no biliary injury in all patients. While in the choledochal cyst group; common bile duct, cystic duct, and common hepatic duct were evident in all patients with no biliary injury. In the biliary atresia group, there was statistically significant differences between preoperative and postoperative liver profiles regarding aspartate aminotransferase, alanine aminotransferase, total and direct bilirubin, alkaline phosphatase, and gamma-glutamyltransferase.
Conclusion
The ICG fluorescence application in pediatric hepatobiliary surgery is feasible and safe with the mentioned doses and timing of administrations. Adequate visualization of ICG fluorescence helped to prevent intraoperative vascular or biliary complications in our study population.

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