title: Application of fluorescent cholangiography to single-incision laparoscopic cholecystectomy.
abstract: BACKGROUND
  Although the use of single-incision laparoscopic cholecystectomy (SILC) is spreading rapidly, this technique has disadvantages. It does not allow for sufficient surgical views to be obtained or for intraoperative radiographic cholangiography to be performed. Fluorescent cholangiography using a preoperative intravenous injection of indocyanine green (ICG) may be useful for identifying the biliary tract during both SILC and conventional laparoscopic cholecystectomy.
  
  
  METHODS
  For seven patients undergoing SILC, 1 ml of ICG (2.5 mg) was administered by intravenous injection before the surgery. The prototype fluorescent imaging system consisted of a xenon light source and a 30° laparoscope (diameter, 10 mm) equipped with a charge-coupled device camera capable of filtering out light with wavelengths shorter than 810 nm. The laparoscope was introduced through an umbilical trocar. Fluorescent cholangiography then was performed by changing the color images to fluorescent images using a foot switch during dissection of the triangle of Calot.
  
  
  RESULTS
  Fluorescent cholangiography identified the confluence between the cystic duct and the common hepatic duct in all seven patients before and throughout the dissection of the triangle of Calot. The interval from the injection of ICG to the first obtained fluorescent cholangiography before dissection of the triangle of Calot ranged from 35 to 75 min.
  
  
  CONCLUSIONS
  Fluorescent cholangiography enabled real-time identification of the extrahepatic bile ducts during SILC without necessitating catheterization of the bile duct. Such properties of fluorescent cholangiography are expected to be helpful for ensuring the safety of SILC and expanding the indications for the procedure.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ishizawa
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Inoue
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takemura
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Seyama
authors.forename: Taku
authors.initials: T
authors.lastname: Aoki
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Beck
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Harada
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Ijichi
authors.forename: Koji
authors.initials: K
authors.lastname: Kusaka
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shibasaki
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Bandai
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D000328:Adult; D000368:Aged; D002758:Cholangiography / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green