[Experience of indocyanine green use in acute calculous cholecystitis].

OBJECTIVE

To assess the safety and effectiveness of the indocyanine green use in acute cholecystitis for identification of anatomical variants of the biliary tree; prevention and timely detection of intraoperative complications.

MATERIAL AND

METHODS

The medication of indocyanine green made by OOO «Ferment» domestic manufacturer was used. The drug dose from 2.5 mg to 10 mg was applied according to studied materials (8). Time of the surgery beginning was from 2 to 6 hours after intravenous injection of aqueous solution, respectively. In addition, it has been established that the optimal drug dose is 5 mg. The surgery should be performed not earlier than 3 hours after, but no later than 6 hours. This allows to achieve the most comfortable fluorescence of the extrahepatic biliary tract. The drug concentration in the liver cells decreases by this time and increases in the biliary tract. It is not always possible to perform the operation strictly within the specified time limit considering the urgency of the surgical intervention. In this connection, the surgery was carried out not earlier than 3 hours after the drug injection, but not later than 6 hours. Endoscopic equipment with the ability to display near-infrared fluorescence was used. A laser light source with a wavelength of 820 nm in the Arthrex imaging system with 4K resolution as well as the Olympus imaging system with HD resolution were used for fluorescence excitation.

RESULTS

The implementation of intraoperative fluorescent navigation with indocyanine green contributes to the improvement of safety and effectiveness of surgical treatment through visualization of topography and identification of anatomical variants of the biliary tree; possibilities of prevention and timely detection of intraoperative complications. The use of indocyanine green allows to intraoperatively reveal atypical location and different variations of the extrahepatic biliary tract.