title: Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy.
abstract: BACKGROUND
  Intraoperative cholangiography (IOC) is the current gold standard for biliary imaging during laparoscopic cholecystectomy (LC). However, utilization of IOC remains low. Near-infrared fluorescence cholangiography (NIRF-C) is a novel, noninvasive method for real-time, intraoperative biliary mapping. Our aims were to assess the safety and efficacy of NIRF-C for identification of biliary anatomy during LC.
  
  
  METHODS
  Patients were administered indocyanine green (ICG) prior to surgery. NIRF-C was used to identify extrahepatic biliary structures before and after partial and complete dissection of Calot's triangle. Routine IOC was performed in each case. Identification of biliary structures using NIRF-C and IOC, and time required to complete each procedure were collected.
  
  
  RESULTS
  Eighty-two patients underwent elective LC with NIRF-C and IOC. Mean age and body mass index (BMI) were 42.6 ± 13.7 years and 31.5 ± 8.2 kg/m(2), respectively. ICG was administered 73.8 ± 26.4 min prior to incision. NIRF-C was significantly faster than IOC (1.9 ± 1.7 vs. 11.8 ± 5.3 min, p < 0.001). IOC was unobtainable in 20 (24.4 %) patients while NIRF-C did not visualize biliary structures in 4 (4.9 %) patients. After complete dissection, the rates of visualization of the cystic duct, common bile duct, and common hepatic duct using NIRF-C were 95.1, 76.8, and 69.5 %, respectively, compared to 72.0, 75.6, and 74.3 % for IOC. In 20 patients where IOC could not be obtained, NIRF-C successfully identified biliary structures in 80 % of the cases. Higher BMI was not a deterrent to visualization of anatomy with NIRF-C. No adverse events were observed with NIRF-C.
  
  
  CONCLUSIONS
  NIRF-C is a safe and effective alternative to IOC for imaging extrahepatic biliary structures during LC. This technique should be evaluated further under a variety of acute and chronic gallbladder inflammatory conditions to determine its usefulness in biliary ductal identification.
authors.affiliation: Division of General and Gastrointestinal Surgery, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 558 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
authors.forename: Sylvester N
authors.initials: SN
authors.lastname: Osayi
authors.forename: Mark R
authors.initials: MR
authors.lastname: Wendling
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Drosdeck
authors.forename: Umer I
authors.initials: UI
authors.lastname: Chaudhry
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Perry
authors.forename: Sabrena F
authors.initials: SF
authors.lastname: Noria
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Mikami
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Needleman
authors.forename: Peter
authors.initials: P
authors.lastname: Muscarella
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abdel-Rasoul
authors.forename: David B
authors.initials: DB
authors.lastname: Renton
authors.forename: W Scott
authors.initials: WS
authors.lastname: Melvin
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Hazey
authors.forename: Vimal K
authors.initials: VK
authors.lastname: Narula
mesh_terms: D000328:Adult; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging*; D002758:Cholangiography / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D004396:Coloring Agents; D003135:Common Bile Duct / Q000000981:diagnostic imaging; D003549:Cystic Duct / Q000000981:diagnostic imaging; D003952:Diagnostic Imaging; D005260:Female; D006500:Hepatic Duct, Common / Q000000981:diagnostic imaging; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green