ArticleSurgical endoscopy2026
Intraoperative biliary anatomy visualization using indocyanine green fluorescence micro-dosing: a quantitative preclinical study.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe critical view of safety aims to reduce bile duct injury during laparoscopic cholecystectomy. Near-infrared (NIR) fluorescence cholangiography with indocyanine green (ICG) may enhance visualization of extrahepatic biliary anatomy, but conventional dosing can increase hepatic background fluorescence and optimal weight-adjusted strategies remain unclear. This study quantitatively evaluated weight-adjusted systemic ICG regimens within a predefined micro-dose domain and assessed the temporal stability of bile duct-to-liver fluorescence contrast within an operative time window.
methodsTen pigs received a single randomized intravenous injection of ICG at one of five weight-adjusted doses (0.000625, 0.004, 0.01, 0.025, or 0.05 mg/kg). NIR fluorescence imaging was performed at 30, 60, and 90 min using a standardized laparoscopic platform in overlay mode. Extrahepatic bile ducts and hepatic parenchyma were manually segmented in Computer Vision Annotation Tool to generate masks. Pixel-wise intensity extraction was aggregated to obtain one bile duct-to-liver contrast ratio per animal per time point. Data were analyzed using a linear mixed-effects model with animal as a random effect.
resultsFluorescence was detectable in all animals from 30 to 90 min across all dose regimens. When doses were grouped into a predefined micro-dose domain (≤ 0.01 mg/kg; n = 6 animals) versus higher doses (≥ 0.025 mg/kg; n = 4 animals), mixed-effects modeling showed a main effect of dose group (F(1,8) = 6.539, p = 0.034), with consistently higher estimated marginal mean contrast ratios in the micro-dose domain (ΔEMM = 2.350 ratio units, 95%CI 0.549-4.152). No significant effect of time was observed (F(2,18) = 0.824, p = 0.455) within the 30-90 min window evaluated.
conclusionsSystemic weight-adjusted micro-dose ICG administration provided higher bile duct-to-liver contrast in a preclinical model within the operative window evaluated. These findings support further investigation of standardized micro-dose protocols and quantitative fluorescence-guided strategies in clinical settings.
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