Evidence map›Paper›PMID 40789781›Full record

ArticleSurgical endoscopy2025

How low can you go? Intraoperative microdosing of indocyanine green for fluorescence cholangiography during laparoscopic cholecystectomy.

Ryan C Broderick, Graham J Spurzem, Ana Garcia Cabrera, Patricia Ruiz-Cota, Amanda Rocha, Edgardo Reyes, Agustina Altolaguirre, Andres Fontaine-Nicola, Hannah M Hollandsworth, Bryan J Sandler and 2 more

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Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
  4. Article
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Ryan C BroderickDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA.
Graham J SpurzemDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA. gspurzem@health.ucsd.edu.ORCID http://orcid.org/0000-0002-1134-1754
Ana Garcia CabreraDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA.
Patricia Ruiz-CotaDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA.
Amanda RochaDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA.
Edgardo ReyesDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA.
Agustina AltolaguirreDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA.
Andres Fontaine-NicolaDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA.
Hannah M HollandsworthDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA.
Bryan J SandlerDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA.
Santiago HorganDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA.
Garth R JacobsenDepartment of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr., La Jolla, San Diego, CA, 92037, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFluorescence cholangiography (FC) with indocyanine green (ICG) enables real-time intraoperative visualization of extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC). There is no consensus on the optimal ICG dose or timing of administration for LC. The goal of this study was to implement a simple intraoperative low-dose ("microdose") ICG protocol that facilitates non-inferior biliary visualization compared to a standard dose protocol to streamline perioperative workflows.

methodsA retrospective review of a prospectively maintained database identified patients who underwent LC at our institution from 2021 to 2024. Microdose protocol patients were intravenously administered 0.5 mg ICG upon induction of general anesthesia, while standard protocol patients received 7.5 mg ICG 60-120 min preoperatively. Operative video from cases in both groups were reviewed to compare the frequency of cystic duct (CD), common bile duct (CBD), and common hepatic duct (CHD) visualization with FC. A 4-point Likert scale survey was completed for each case to compare ICG signal strength (1 = no signal; 4 = very strong), clarity from background interference (1 = cannot discern signal from background; 4 = no interference), and usefulness in clinical decision-making (1 = no benefit; 4 = essential).

resultsA total of 100 patients were identified (N = 50 microdose; N = 50 standard). For microdose cases, the mean time from ICG administration to skin incision was 16.7 ± 5.6 min, and mean operative time was 47.4 ± 20.2 min. Compared to 50 standard dose cases, CD visualization before hepatocystic triangle dissection with the microdose protocol was 86.0% vs 88.0% (p = 0.99). The CBD and CHD were seen in all cases for both groups. There were no significant differences in average score for signal strength (3.6 ± 0.5 vs 3.7 ± 0.5, p = 0.32), signal clarity (3.4 ± 0.5 vs 3.3 ± 0.5, p = 0.32), or usefulness in clinical decision-making (4.0 ± 0.0 vs 4.0 ± 0.0, p = 0.99) between groups.

conclusionMicrodose ICG can be given intraoperatively to provide excellent biliary visualization during laparoscopic cholecystectomy, eliminating the historical workflow of preoperative ICG administration.

Indexed as

CholangiographyCholecystectomy, LaparoscopicColoring AgentsIndocyanine GreenIntraoperative CareAdultAgedFemaleHumansMaleMiddle AgedRetrospective StudiesColoring AgentsIndocyanine GreenFluorescence cholangiographyIndocyanine greenLaparoscopic cholecystectomyMicrodoseMinimally invasive surgery

Identifiers

PMID40789781
PMCPMC12500773

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.