Fluorescence cholangiography during laparoscopic cholecystectomy: a feasibility study on early biliary tract delineation.
BACKGROUND
Laparoscopic cholecystectomy (LC) is one of the most commonly performed laparoscopic procedures. Bile duct injury is a rare but serious complication during this procedure, mostly caused by misidentification of the extrahepatic bile duct anatomy. Intraoperative cholangiography may be helpful to reduce the risk of bile duct injury; however, this is not a common procedure worldwide. Near-infrared fluorescence cholangiography (NIRFC) using indocyanine green (ICG) is a promising alternative for the identification of the biliary tree. This prospective observational study was designed to assess the feasibility and image quality of intermittent NIRFC during LC, using a newly developed laparoscopic fluorescence system.


METHODS
Consecutive patients undergoing elective LC were included and received a single intravenous injection of ICG directly after induction of anesthesia. During dissection of the base of the gallbladder and the cystic duct, the extrahepatic bile ducts were visualized by using a dedicated laparoscope, which offers both conventional state-of-the-art imaging and fluorescence imaging. Intraoperative recognition of the biliary structures was registered at set time points, as well as the establishment of the critical view of safety.


RESULTS
Fifteen patients were included between December 2011 and May 2012. ICG was visible in the liver and bile ducts within 20 min after intravenous administration and remained for approximately 2 h, using the fluorescence mode of the laparoscope. The common bile duct and cystic duct could be clearly identified at an early stage of the operation and, more important, significantly earlier than with the conventional camera mode. No per- or postoperative complications occurred as a consequence of ICG use.


CONCLUSIONS
Intermittent fluorescence imaging using a newly developed laparoscope and preoperative administration of ICG seems a useful aid in accelerating visualization of the extrahepatic bile ducts during laparoscopic cholecystectomy.
Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands. rutgermschols@hotmail.com
Rutger M
RM
Schols
Nicole D
ND
Bouvy
Ad A M
AA
Masclee
Ronald M
RM
van Dam
Cornelis H C
CH
Dejong
Laurents P S
LP
Stassen
D000328:Adult; D000368:Aged; D001659:Biliary Tract / Q000473:pathology*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002764:Cholecystitis / Q000473:pathology / Q000601:surgery; D002769:Cholelithiasis / Q000473:pathology / Q000601:surgery; D003199:Computer Systems; D003287:Contrast Media; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005453:Fluorescence; D005456:Fluorescent Dyes; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007208:Indocyanine Green; D007430:Intraoperative Care; D020706:Laparoscopes; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000295:instrumentation / Q000379:methods*
D003287:Contrast Media; D005456:Fluorescent Dyes; D007208:Indocyanine Green