title: Effectiveness of intraoperative cholangiography using indocyanine green (versus contrast fluid) for the correct assessment of extrahepatic bile ducts during day-case laparoscopic cholecystectomy.
abstract: BACKGROUND
  During cholecystectomy, intraoperative cholangiography using contrast fluid (IOC-CF) is still the "gold standard" for biliary tract identification but has many associated pitfalls. A new IOC technique using indocyanine green (IOC-IG) appears to be promising. Here, we studied the effectiveness of IOC-IG (vs IOC-CF) during day-case laparoscopic cholecystectomy.
  
  
  METHODS
  Over a 6-month period, we included 23 patients (with no cirrhosis or risk factors for choledocholithiasis) scheduled for day-case laparoscopic cholecystectomy. The primary efficacy criterion was the "analyzability rate" (i.e., the ability to identify the cystic duct, the cystic duct-hepatic duct junction, and the common bile duct) for the IOC-CF and IOC-IG procedures after dissection. Indocyanine green was infused under general anesthesia. The same near-infrared laparoscopic imaging system was used for IOC-IG and conventional visual inspection. IOC-CF was always attempted after dissection. Each patient served as his/her own control. Cholecystectomies were video-recorded for subsequent off-line, blind analysis.
  
  
  RESULTS
  The analyzability rate was 74 % for IOC-IG after dissection, 70 % for IOC-CF (p = 0.03), 26 % for conventional visual inspection, and 48 % for IOC-IG before dissection. When each IOC modality (conventional visual inspection, IOC-IG before and after dissection) was considered as a diagnostic test, the accuracy for simultaneous identification of the three anatomic elements was respectively 48, 52, and 74 %. No adverse events occurred during the IOC-IG procedure.
  
  
  CONCLUSIONS
  IOC-IG was feasible and safe. Our results suggest that this technique is more effective than IOC-CF for biliary tract identification after dissection and may constitute a powerful diagnostic test for the detection of extrahepatic ducts.
authors.affiliation: Department of Digestive and Metabolic Surgery, North Hospital, Amiens University Medical Center, Place Victor Pauchet, F-80054, Amiens, Cedex 1, France.
authors.forename: F
authors.initials: F
authors.lastname: Prevot
authors.forename: L
authors.initials: L
authors.lastname: Rebibo
authors.forename: C
authors.initials: C
authors.lastname: Cosse
authors.forename: F
authors.initials: F
authors.lastname: Browet
authors.forename: C
authors.initials: C
authors.lastname: Sabbagh
authors.forename: J-M
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging*; D002758:Cholangiography / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery; D005260:Female; D005456:Fluorescent Dyes; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome; D014741:Video Recording; D055815:Young Adult
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green