title: Cost analysis and effectiveness comparing the routine use of intraoperative fluorescent cholangiography with fluoroscopic cholangiogram in patients undergoing laparoscopic cholecystectomy.
abstract: BACKGROUND
  Despite the standardization of laparoscopic cholecystectomy (LC), the rate of bile duct injury (BDI) has risen from 0.2 to 0.5%. Routine use of intraoperative cholangiography (IOC) has not been widely accepted because of its cost and a lack of evidence concerning its use in preventing BDI. Fluorescent cholangiography (FC), which has recently been advocated as an alternative to IOC, is a novel intraoperative procedure involving infrared visualization of the biliary structures. This study evaluated costs and effectiveness of routinely implemented FC and IOC during LC.
  
  
  METHODS
  Between February and June 2013, the authors prospectively collected the data of all patients undergoing laparoscopic cholecystectomy. We retrospectively reviewed and compared the use of FC and IOC. Procedure time, procedure cost, and effectiveness of the two methods were analyzed and compared. The surgeons involved in the cases completed a survey on the usefulness of each method.
  
  
  RESULTS
  A total of 43 patients (21 males and 22 females) were analyzed during the study period. Mean age was 49.53 ± 14.35 years and mean body mass index was 28.35 ± 8 kg/m(2). Overall mean operative time was 64.95 ± 17.43 min. FC was faster than IOC (0.71 ± 0.26 vs. 7.15 ± 3.76 min; p < 0.0001). FC was successfully performed in 43 of 43 cases (100%) and IOC in 40 of 43 cases (93.02%). FC was less expensive than IOC (US$14.10 ± 4.31 vs. US$778.43 ± 0.40; p < 0.0001). According to the survey, all surgeons found routine use of FC useful.
  
  
  CONCLUSIONS
  In this study, FC was effective in delineating important anatomic structures. It required less time and expense than IOC, and was perceived by the surgeons to be easier to perform, and at least as useful as IOC. Further prospective studies are warranted to evaluate the effectiveness of FC in decreasing BDI.
authors.affiliation: Section of Minimally Invasive Surgery, Department of General Surgery, The Bariatric & Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA, fernandodip@gmail.com.
authors.forename: Fernando D
authors.initials: FD
authors.lastname: Dip
authors.forename: Domenech
authors.initials: D
authors.lastname: Asbun
authors.forename: Armando
authors.initials: A
authors.lastname: Rosales-Velderrain
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lo Menzo
authors.forename: Conrad H
authors.initials: CH
authors.lastname: Simpfendorfer
authors.forename: Samuel
authors.initials: S
authors.lastname: Szomstein
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Rosenthal
mesh_terms: D001649:Bile Duct Diseases / Q000191:economics / Q000601:surgery; D001652:Bile Ducts / Q000293:injuries / Q000601:surgery; D002758:Cholangiography / Q000191:economics*; D017081:Cholecystectomy, Laparoscopic / Q000191:economics*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D005431:Florida; D005471:Fluoroscopy / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000191:economics*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000191:economics*; D011795:Surveys and Questionnaires