Chapter 5 Abstract Background Near‐infrared fluorescence laparoscopy after intravenous indocyanine green (ICG) administration has been proposed as a promising surgical imaging technique for real‐time 66 visualization of the extra‐hepatic bile ducts and arteries in clinical laparoscopic cholecystectomies. However, optimization of this new technique with respect to the imaging system combined with the fluorophore is desirable. The performance of a pre‐clinical near‐infrared dye CW800‐CA was compared with ICG for near‐infrared fluorescence laparoscopy of the cystic duct and artery in pigs. Methods Laparoscopic cholecystectomy was performed in six pigs (35 kg) using a commercially available laparoscopic fluorescence imaging system. The fluorophores CW800‐CA and ICG (both 800 nm fluorescent dyes) were administered by intravenous injection in four and two pigs respectively. CW800‐CA was administered in three different doses (consecutively 0.25, 1 and 3 mg), ICG was intravenously injected (2.5 mg) for comparison. Intraoperative recognition of the biliary structures was registered at set time points. Target‐to‐background‐ratio was determined to quantify the fluorescence signal of the designated tissues. Results A clinically proven dose of 2.5 mg ICG resulted in a successful fluorescence delineation of both the cystic duct and artery. In the CW800‐CA injected pigs a clear visualization of the cystic duct and artery was obtained after administration of 3 mg CW800‐CA. Time from injection until fluorescence identification of the cystic duct was reduced when CW800‐CA was used compared with ICG (respectively 11.5 versus 21.5 minutes). CW800‐CA provided clearer illumination of the cystic artery, in terms of target‐to‐background‐ ratio. Conclusion Next to ICG, CW800‐CA can be applied for fluorescence identification of the cystic artery and duct using a commercially available laparoscopic fluorescence imaging system. Fluorescence cholangiography of the cystic duct can be obtained earlier after intravenous injection of CW800‐CA, compared to ICG. These findings increase the possibilities of use and of optimization of this imaging technique.
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