ICG FACILITY IN LAPAROSCOPIC CHOLECYSTECTOMY

ROLE OF INDOCYANINE GREEN (ICG) IN GALL BLADDER SURGERY (SEVENTEEN)

    Indocyanine green is also known as the florescent dye. This dye is injected intravenously 45 minutes before surgery. It is actually the one that helps light the path for better and real-time identification of the biliary anatomy during Laparoscopic Cholecystectomy. There is a florescent imaging system that is usually used together with a laparoscope. The system must have a lighting system that provides light for both infrared and xenon rays. Indocyanine green acts as an imaging agent, which is sterile, water soluble, and has a peak spectral absorption averaging at 805 nm. It does not undergo enterohepatic recirculation. It only stays in the bile for about 8 minutes after injection. The removal of ICG depends on several factors, including the blood flow of the liver, biliary excretion, and parenchymal cellular function. It is contraindicated in those having iodine toxicity and better to avoid in pregnant or post-partum ladies.   

    Apart from its role to analyse the extrahepatic biliary anatomy better, thus reducing the incidence of bile duct injury, it also plays a role in identifying the anatomic structure in a quick manner, thereby reducing the time used in performing the procedure of cholangiography and hence also shortening the entire duration of surgery. There is also no need to bring onboard additional equipment and manpower, especially the radiological personnel for X-ray examination. The technique of ICG also plays a role as a teaching tool for practitioners who are able to identify the relevant extrahepatic structures in almost every patient. This makes them experienced with the procedure that makes it easier for them to perform future procedure. It does not require X-ray; thus no one is exposed to radiation. The ICG that is used is usually safe and does not cause any adverse reaction in patients. It is also cost-effective.