Vojtech Dotlacil, Eliska Pajerova, Dagmar Sovadinova, Barbora Kucerova, Martin Vyhnanek & Michal Rygl | Pediatric Surgery International | 26 August 2025 | IF: 1,6 | doi
MUDr. Vojtěch Dotlačil, Department of Paediatrics Surgery, Second Faculty od Medicine and Motol University Hospital
Abstract:
Purpose
Indocyanine green (ICG) fluorescence imaging enhances biliary visualization during pediatric laparoscopic cholecystectomy (LC), helping to identify anatomical variants and prevent bile duct injury. Standard pediatric recommendations suggest ICG administration 16–24 h preoperatively; however, this may be impractical. This study aims to evaluate the safety and effectiveness of short-interval ICG administration.
Methods
A prospective single-center study (October 2024–June 2025) included pediatric LC patients receiving intravenous Verdye® preoperatively. Visualization of extrahepatic biliary anatomy was assessed intraoperatively using a 5-point Likert scale, HELPFUL (usefulness), and DISTURBED (liver background interference) scores. Data included indication, ICG timing, operative time, and complications according to the Clavien–Dindo classification (C–D).
Results
Eleven patients (64% female), median age 14 years (IQR 12,7–15,7) and median weight 65,5 kg (IQR 46,5–80), were included. Five had BMI > 25 kg/m2; five (46%) underwent preoperative ERCP. ICG (median dose 0.34 mg/kg) was administered a median of 225 min before surgery. Median operative time was 65 min (IQR 58–68). Median Likert score was 5; HELPFUL 3; DISTURBED 1. No ICG-related or C–D complications occurred.
Conclusion
Short-interval ICG administration was safe, feasible, and effective in enhancing biliary visualization during pediatric LC. This approach was well-tolerated and provided high-quality imaging without complications.
