title: Real-time near-infrared (NIR) fluorescent cholangiography in single-site robotic cholecystectomy (SSRC): a single-institutional prospective study.
abstract: BACKGROUND
  Bile duct injury is a rare but serious complication of laparoscopic cholecystectomy and the primary cause is misinterpretation of biliary anatomy. This may occur more frequently with a single-incision approach due to difficulties in exposing and visualizing the triangle of Calot. Intraoperative cholangiography was proposed to overcome this problem, but due to multiple issues, it is not used routinely. Indocyanine green (ICG) near-infrared (NIR) fluorescent cholangiography is non invasive and provides real-time biliary images during surgery, which may improve the safety of single-incision cholecystectomy. This study aims to evaluate the efficacy and safety of this technique during single-site robotic cholecystectomy (SSRC).
  
  
  METHODS
  Patients presenting with symptomatic biliary gallstones without suspicion of common bile duct stones underwent SSRC with ICG-NIR fluorescent cholangiography using the da Vinci Fluorescence Imaging Vision System. During patient preparation, 2.5 mg of ICG was injected intravenously. During surgery, the biliary anatomy was imaged in real time, which guided dissection of Calot's triangle. Perioperative outcomes included biliary tree visualizations, operative time, conversion and complications rates, and length of hospital stay.
  
  
  RESULTS
  There were 45 cases between July 2011 and January 2012. All procedures were completed successfully; there were no conversions and at least one structure was visualized in each patient. The rates of visualization were 93 % for the cystic duct, 88 % for the common hepatic duct, and 91 % for the common bile duct prior to Calot's dissection; after Calot's dissection, the rates were 97 % for all three ducts. Mean hospital stay was 1.1 days and there were no bile duct injuries or any other major complications.
  
  
  CONCLUSIONS
  Real-time high-resolution fluorescent imaging to identify the biliary tree anatomy during SSRC using the da Vinci Fluorescence Imaging Vision System was safe and effective.
authors.affiliation: Department of Surgery, SS Antonio e Biagio Hospital, Alessandria, Italy. gspinoglio@ospedale.al.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spinoglio
authors.forename: Fabio
authors.initials: F
authors.lastname: Priora
authors.forename: Paolo Pietro
authors.initials: PP
authors.lastname: Bianchi
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Lucido
authors.forename: Alessio
authors.initials: A
authors.lastname: Licciardello
authors.forename: Valeria
authors.initials: V
authors.lastname: Maglione
authors.forename: Federica
authors.initials: F
authors.lastname: Grosso
authors.forename: Raul
authors.initials: R
authors.lastname: Quarati
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Ravazzoni
authors.forename: Luca Matteo
authors.initials: LM
authors.lastname: Lenti
mesh_terms: D000328:Adult; D000368:Aged; D002758:Cholangiography / Q000295:instrumentation / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D004396:Coloring Agents; D004867:Equipment Design; D005260:Female; D005453:Fluorescence; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012371:Robotics / Q000379:methods*; D019265:Spectroscopy, Near-Infrared; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green