# Enhancing biliary structure identification using percutaneous cholecystostomy drain delivery of indocyanine green: a glowing two case review

## TL;DR

This case review shows how using indocyanine green through a drainage catheter improves biliary structure visualization during cholecystectomy in patients with cholecystitis.

## Contribution

A novel method of delivering indocyanine green via percutaneous cholecystostomy catheters for fluorescent cholangiography is demonstrated.

## Key findings

- Injecting indocyanine green through drainage catheters reliably visualizes the biliary system.
- This method avoids hepatic fluorescence and improves contrast for biliary anatomy identification.

## Abstract

The use of indocyanine green for fluorescent cholangiography in patients with cholecystitis initially treated with percutaneous cholecystostomy drainage catheters was described in this two case series. Two patients underwent robotic assisted cholecystectomy with fluorescent cholangiography and indocyanine green through percutaneous cholecystostomy drainage catheters. The patients were diagnosed with acute cholecystitis. Directed injection of indocyanine green allowed for direct visualization of the biliary system allowing for a safe identification of the critical view of safety. Injection of indocyanine green for fluorescent cholangiography through percutaneous cholecystostomy drainage catheters is reliable to assess the critical view of safety and allows for improved identification of the biliary tree anatomy. Administration of indocyanine green through the percutaneous cholecystostomy drainage catheters avoided background hepatic fluorescence and increased contrast between biliary structures.