Efficacy of multi-color near-infrared fluorescence with indocyanine green: A new imaging strategy and its early experience in laparoscopic cholecystectomy

Background: Near-infrared fluorescence imaging via using intravenous indocyanine green (ICG) has a wide range of applications in multiple surgical scenarios. In laparoscopic cholecystectomy (LC), it facilitates intraoperative identification of the biliary system and reduces the risk of bile duct injury. However, the usual single color fluorescence imaging (SCFI) has limitations in manifesting the fluorescence signal of the target structure when its intensity is relatively low. Moreover, surgeons often experience visual fatigue. We hypothesized that a novel imaging strategy, named multi-color fluorescence imaging (MCFI), could potentially address these issues by decreasing hepatic and background fluorescence pollution and improving biliary visualization.

Aim: To investigate the novel imaging strategy MCFI in LC.

Methods: This was a single-center retrospective study conducted at Peking Union Medical College Hospital, Beijing, China. Patients who underwent LC from June 2022 to March 2023 by the same surgical team were enrolled. Demographic features, clinical and surgical information were collected. The clarity, visual comfort, and effectiveness of different imaging strategies were subjectively evaluated by surgeons.

Results: A total of 155 patients were included, 60 patients were in the non-ICG group in which only bright light illuminance without ICG was applied, 60 patients were in the SCFI group, and 35 patients were in the MCFI group. No statistically significant differences were found in demographics or clinical history. Post-surgical complications were minimal in all 3 groups with no significant differences observed. MCFI improved the clarity of imaging and visual comfort. Clarity of imaging and visual comfort were improved with MCFI.

Conclusion: MCFI improves biliary visualization and reduces liver fluorescence contamination, which supports its routine use in LC. MCFI may also be a better choice than SCFI in other clinical settings.