VERDYE™ Indocyanine Green is cleared exclusively through the liver and then excreted through the bile. It does not undergo metabolism. Verdye ICG in recent years has experienced increased interest within HPB Surgery because of its clearance characteristics. The ICG fluorescence imaging (FI) technique helps to guide the hepatic surgical procedures and provides the surgeon with real-time visualisation of the fluorescent structures in:
While numerous clinical parameters are used to assess a patient’s liver function, the ICG test is the gold standard and is the only established test for estimating true global liver function.1
Assessment of dynamic liver function is crucial in the pre-operative preparation of those who require extensive liver resections, liver transplants and also to monitor liver function in a post-operative setting. The ICG clearance or the elimination test is the most widely used quantitative liver function test.
1Geisel D, Lüdemann L, Hamm B, Denecke T. Imaging-Based Liver Function Tests–Past, Present and Future. Rofo. 2015;187(10):863-871. doi:10.1055/s-0035-1553306
Laparoscopic Cholecystectomy is the gold standard for gall bladder surgery and is one of the most common surgeries undertaken worldwide. Whilst the incidence of Bile Duct Injury (BDI) is low at 0.5%, due to the considerable amount of surgeries, this becomes quite a significant number with thousands of resultant patients per year thus sustaining BDI’s, with severe and long term implications for their health.1 The primary cause of error in 97% of Lap Chole cases was a visual perception illusion, which is one of the major drawbacks of an MIS approach.2
Surgeons had a 3-fold improvement in ability to visualise critical bile duct structures using ICG.3
1.Pucher PH, Brunt LM, Davies N, et al. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surgical Endoscopy (2018) 32:2175–2183
2.Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003;237(4):460-469. doi:10.1097/01.SLA.0000060680.92690.E9
3Dip F, LoMenzo E, Sarotto L, et al. Randomized Trial of Near-infrared Incisionless Fluorescent Cholangiography. Ann Surg. 2019;270(6):992-999. doi:10.1097/SLA.0000000000003178
Over the last few decades, imaging technologies in hepatobiliary (HPB) surgery have become indispensable tools for liver surgeons. The ICG fluorescence imaging (FI) technique helps to guide the hepatic surgical procedures and provides the surgeon with real-time visualisation of the fluorescent structures of interest that would be invisible under conventional white light.
A retrospective study suggest that near infra-red fluorescence imaging (NIRF) using ICG preventing recurrences in a subset of patients with colorectal liver metastases (CRLM), because of identification of significantly more and smaller tumors1. NIRF has also the potential to aid surgeons in achieving a tumor negative margin in minimally invasive liver metastasectomies2
1Handgraaf HJM, Boogerd LSF, Höppener DJ, et al. Long-term follow-up after near-infrared fluorescence-guided resection of colorectal liver metastases: A retrospective multicenter analysis. Eur J Surg Oncol. 2017;43(8):1463-1471. doi:10.1016/j.ejso.2017.04.016
2Achterberg FM, Sibinga Mulder BG, Meijer RPJ, et al. Real-time surgical margin assessment using ICG-fluorescence during laparoscopic and robot-assisted resections of colorectal liver metastases: A retrospective multicenter analysis. Ann Transl Med. 2020 Nov;8(21):1448. doi: 10.21037/atm-20-1999
