Efficacy of Intraoperative vs Preoperative Indocyanine Green Administration for Near-Infrared Cholangiography During Laparoscopic Cholecystectomy: An Open-Label, Noninferiority, Randomized Controlled Trial.

Abstract

Near-infrared fluorescence cholangiography improves the clinical effects of laparoscopic cholecystectomy. However, the administration of indocyanine green remains controversial. Both the intraoperative strategy (IS, 0.05 mg) and preoperative strategy (PS, 0.25 mg/kg body weight, 1 day before operation) have been shown to be superior to the standard strategy (2.5 mg, intraoperative). This trial was designed to determine whether IS offers noninferior visualization of biliary ducts compared with PS. A total of 168 eligible patients undergoing laparoscopic cholecystectomy were enrolled in this noninferiority, open-label, randomized controlled trial at Zhujiang hospital between August 2023 and November 2023. Participants were randomized in a 1:1 ratio into PS and IS groups after stratification by BMI and inflammation level. The fluorescence visualization of biliary structures was assessed by comparing the signal-to-background ratio (SBR) and surgeon evaluations. The common bile duct-liver SBR did not significantly differ between IS and PS groups (3.0 ± 0.8 vs 3.1 ± 1.2; p = 0.636). The liver fluorescence intensity of the IS group was significantly lower than that of the PS group (46.3 ± 12.9 vs 70.4 ± 26.2; p < 0.01). The visualization score of common hepatic ducts was significantly greater in the IS than in the PS group (4.1 ± 0.7 vs 3.7 ± 0.6; p< 0.01). The critical view of safety was achieved more rapidly in the IS group compared with the PS group (9.4 vs 11.0 minutes, p < 0.01). Although IS did not improve the SBR, it significantly reduced the fluorescence intensity of the liver background, potentially enhancing the surgeon's subjective perception and thereby increasing the visualization score. Compared with PS, IS offers greater convenience and is more effective in facilitating critical view of safety exposure.