title: Real-time near-infrared fluorescent cholangiography could shorten operative time during robotic single-site cholecystectomy.
abstract: BACKGROUND
  With the introduction of a new platform, robotic single-site cholecystectomy (RSSC) has been reported as feasible and safe for selected cases. In parallel, the development of real-time near-infrared fluorescent cholangiography using indocyanine green (ICG) has been seen as a help during the dissection, even if the data are still preliminary. The study purpose is to report our experience with ICG RSSC and compare the outcomes to standard RSSC.
  
  
  METHODS
  From February 2011 to December 2011, 44 selected patients underwent RSSC for symptomatic cholelithiasis. Among them, 23 (52.3%) were included in an experimental protocol using the ICG, and the remainder (47.7%) underwent standard RSSC. There was no randomization. The endpoints were the perioperative outcomes. This is a prospective study, approved by our local Ethics Committee.
  
  
  RESULTS
  There were no differences in terms of patients' characteristics, except that there were more male patients in the ICG group (47.8 vs. 9.5%; p = 0.008). Regarding the surgical data, the overall operative time was shorter for the ICG group, especially for patients with a body mass index (BMI) ≤25 (-24 min) but without reaching statistical significance (p = 0.06). For BMI >25, no differences were observed. Otherwise, there were no differences in terms of conversion, complications, or length of stay between both groups.
  
  
  CONCLUSIONS
  A RSSC with a real-time near-infrared fluorescent cholangiography can be performed safely. In addition, for selected patients with a low BMI, ICG could shorten the operative time during RSSC. Larger studies are still required before drawing definitive conclusions.
authors.affiliation: Clinic for Visceral and Transplantation Surgery, Department of Surgery, Faculty of Medicine, University Hospital of Geneva, University of Geneva, Rue Gabriel-Perret-Gentil, 4, 1211, Geneva 14, Switzerland, nicolas.c.buchs@hcuge.ch.
authors.forename: Nicolas C
authors.initials: NC
authors.lastname: Buchs
authors.forename: François
authors.initials: F
authors.lastname: Pugin
authors.forename: Dan E
authors.initials: DE
authors.lastname: Azagury
authors.forename: Minoa
authors.initials: M
authors.lastname: Jung
authors.forename: Francesco
authors.initials: F
authors.lastname: Volonte
authors.forename: Monika E
authors.initials: ME
authors.lastname: Hagen
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
mesh_terms: D015992:Body Mass Index; D002758:Cholangiography / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D003199:Computer Systems; D005260:Female; D005456:Fluorescent Dyes; D005470:Fluorometry / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods*; D012371:Robotics / Q000379:methods*; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green