Intra-operative fluorescent cholangiography using indocyanin green during robotic single site cholecystectomy.
OBJECTIVE
Very recently, robotic single site cholecystectomy (RSSC) has been reported feasible and safe for selected cases. While an intra-operative cholangiography can be performed, data is scarce with respect to its use. Indocyanin green (ICG) has been shown to be a viable option to visualize biliary anatomy. Since the introduction of a new near infrared camera integrated to the da Vinci Si System (Intuitive Surgical, Sunnyvale, CA), the surgeon is able to assess the biliary anatomy by a non-invasive and non-ionizing method. This paper presents the first report of ICG imaging during a RSSC.


METHODS
Twelve consecutive patients presenting symptomatic cholelithiasis were prospectively enrolled. They underwent RSSC approximately 45 minutes after intravenous administration of ICG (2.5 mg). The biliary anatomy was analyzed using a near infrared camera integrated to the robot before and after the robotic dissection.


RESULTS
Eight women and four men underwent the procedure. There was a port addition in one case and no peri-operative complications. Mean operative time was 85 minutes (range: 57-125). The cystic, common bile and common hepatic ducts were recognized by fluorescence imaging before the dissection in 91.7%, 50%, and 33.3% of patients, respectively. At least one structure was visualized in 100% of patients. After the completion of Calot's triangle dissection, the cystic, common bile, and common hepatic ducts were recognized in 100%, 83.3%, and 66.7% of cases respectively.


CONCLUSIONS
RSSC using ICG for biliary tree fluorescence imaging can be performed safely. Fluorescent cholangiography enabled real-time identification of the extra-hepatic biliary anatomy using a near infrared camera integrated to the robot. Its routine clinical use merits further investigations.
Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Switzerland. nicolas.c.buchs@hcuge.ch
Nicolas C
NC
Buchs
Monika E
ME
Hagen
François
F
Pugin
Francesco
F
Volonte
Pascal
P
Bucher
Eduardo
E
Schiffer
Philippe
P
Morel
D000328:Adult; D000368:Aged; D002758:Cholangiography / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D002769:Cholelithiasis / Q000473:pathology / Q000601:surgery*; D003199:Computer Systems; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods
D005456:Fluorescent Dyes; D007208:Indocyanine Green