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Live surgeryApril 29, 20231:55:5910 speakersAvailable in: EN / IT

Hot Topics in HPB and Emergency Surgery: the Role of ICG Fluorescence

Permanent School ICG workshop on the role of fluorescence in hepatobiliopancreatic and emergency surgery: cholecystectomy, liver surgery, distal pancreatectomy and intestinal ischemia.

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Clinical case

Patient framing as discussed at case introduction

NotesWorkshop didattico con casi clinici esemplificativi, non live surgery su singolo paziente.

Overview

Third and final 2022 workshop of the Permanent School on ICG Surgery, dedicated to "Hot Topics in HPB and Emergency Surgery". The meeting, opened by Gian Luca Baiocchi and moderated by Felice Borghi, is structured in four keynote lectures, each commented on by an expert discussant tasked with assessing the actual role of indocyanine green fluorescence in their respective surgical fields. The first lecture, by Luigi Boni, addresses fluorescence cholangiography in elective and emergency cholecystectomy, including procedures performed by trainees, with a focus on safety, prevention of bile duct injuries, optimal dosing and timing (1 cc of ICG approximately 40–60 minutes before surgery); Umberto Bracale's commentary discusses the residual indications for conventional radiological cholangiography. Alessandro Ferrero then illustrates the role of ICG in liver surgery for intraoperative staging, margin control and especially anatomical resections with positive and negative staining techniques; Andrea Ruzzenente discusses its limitations (false positives in cirrhotic patients) and reliability compared to intraoperative ultrasound. The third lecture, by Edoardo Rosso, is devoted to lymphadenectomy in distal pancreatectomy for adenocarcinoma, with discussion of the relevant lymph node stations, RAMPS/mesopancreas techniques and the still marginal role of ICG; commentary by Umberto Bracale. Finally, Fausto Catena presents the use of fluorescence in the assessment of intestinal viability in emergency settings (arterial and venous mesenteric ischemia, NOMI, strangulations, open abdomen, critically ill patients on ECMO), highlighting how ICG modifies management in approximately one third of cases and proposing a WSES snapshot trial; closing commentary by Gian Luca Baiocchi.

Topics

Fluorescence cholangiography in cholecystectomy
Prevention of bile duct injuries
ICG dosing and timing
Intraoperative liver staging with ICG
Anatomical liver resections (positive/negative staining)
Lymphadenectomy in distal pancreatectomy
RAMPS technique and mesopancreas
Assessment of intestinal viability in emergency surgery
Arterial and venous mesenteric ischemia
WSES guidelines on ICG

Tools used

Verde di indocianina (ICG)Sistema di imaging Stryker 4KEcografia intraoperatoriaDoppler intraoperatorioRobot chirurgicoLaparoscopiaColangiografia intraoperatoria classicaRicostruzione tridimensionale preoperatoria

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