Use of Indocyanine Green in Acute Cholecystitis

Study Overview
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Brief Summary
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Laparoscopic cholecystectomy is one of the most common gastrointestinal surgeries. However, it can be technically complex in those patients diagnosed with acute cholecystitis who present severe inflammation or fibrosis, with bile duct injury being one of its main complications. The use of fluorescence cholangiography through the use of indocyanine green allows the identification of extrahepatic biliary structures, facilitating dissection and reducing the risk of bile duct lesions. Better visualization of the bile duct allows reducing the conversion rate to open surgery, as well as operating time. The main objective is to assess a decrease in operating time in acute cholecystitis undergoing emergency surgery, to which indocyanine green is administered preoperatively. Randomized, prospective, controlled, multicenter clinical trial of two groups of patients diagnosed with acute cholecystitis and requiring urgent cholecystectomy. The control group includes 220 patients who undergo urgent laparoscopic cholecystectomy according to the usual technique without the administration of indocyanine green, and the intervention group includes 220 patients who undergo urgent laparoscopic cholecystectomy for acute cholecystitis with the administration of indocyanine green preoperatively. Study led by the Parc Taulí University Hospital in Sabadell.

Detailed Description
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Prospective, controlled, randomized and multicenter clinical trial comparing conventional laparoscopic cholecystectomy versus laparoscopic cholecystectomy with preoperative indocyanine green administration in patients with an indication for urgent cholecystectomy due to acute cholecystitis (of any etiology), at the Parc Taulí University Hospital and at the Germans Trias i Pujol University Hospital. Parallel group randomization (1:1) will be performed by opening sealed envelopes, with random assignment between the two groups (intervention and control). The same number of envelopes will be assigned to the study and control group, all of them sealed and placed at random. A four-port laparoscopic cholecystectomy will be performed by a team of surgeons with extensive experience in emergency and/or hepatobiliopancreatic surgery, according to standard techniques and safety measures. Randomization will be carried out at the time of the indication for surgery, after acceptance and signing of the informed consent once all the inclusion criteria are met.

Official Title
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INDURG TRIAL: A Randomized Controlled Trial Using Indocyanine Green During Cholecystectomy in Acute Cholecystitis

Conditions
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Acute Cholecystitis, Bile Duct Injury

Intervention / Treatment
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* Drug: Indocyanine green


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with an indication for urgent laparoscopic cholecystectomy due to acute cholecystitis regardless of its etiology. Age over 18 years. Patients who have read the study information sheet and signed the informed consent sheet. Exclusion Criteria: Pregnant or breastfeeding patients. Grade IV renal failure or patients on dialysis Patients with previous hypersensitivity to indocyanine green Patients with allergy to iodinated contrast Patients with clinical hyperthyroidism, autonomic thyroid adenomas, and focal and diffuse autonomic abnormalities of the thyroid gland Contraindication to laparoscopic surgery. Suspicion of choledocholithiasis Pediatric patients under 18 years of age. Patients who refused to participate in the study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: control group<br>patients who undergo urgent laparoscopic cholecystectomy according to the usual technique without the administration of indocyanine green | |
| Active Comparator: intervention group<br>Patients who undergo urgent laparoscopic cholecystectomy for acute cholecystitis with the administration of indocyanine green preoperatively. | Drug: Indocyanine green<br>* Subjects with a diagnosis of acute cholecystitis who undergo urgent laparoscopic cholecystectomy with the preoperative administration of indocyanine green (between 1-2 hours prior to surgery).<br>* Other names: indocyanine green group;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| operating time | time between the start of the surgical incision and the end of surgery | from the beginning of the surgery to its end, up to 300 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| admission days | days of hospital admission | length of hospital stay, from admission to discharge, up to 3 month | 
| intraoperative complications | surgical injuries during surgery | during surgical time | 
| postoperative morbidity | complications evidenced in the postoperative period | in the first 30 days after surgery | 
| visualization of biliary anatomy with indocyanine green | Evidence the correct visualization of the biliary structures after the administration of indocyanine green | during surgical time | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Indocyanine green