title: Routine use of fluorescent incisionless cholangiography as a new imaging modality during laparoscopic cholecystectomy.
abstract: BACKGROUND
  Intraoperative incisionless fluorescent cholangiography (IOIFC) has been described to identify extrahepatic biliary anatomy. Potential advantages of the routine use of intraoperative incisionless fluorescent cholangiography were evaluated in a consecutive series of cases.
  
  
  METHODS
  A total of 45 patients undergoing laparoscopic cholecystectomy between January and July 2013 were consented and included in this study. We analyzed a prospectively collected database for feasibility, cost, time, usefulness, teaching tool, safety, learning curve, X-ray exposure, complexity, and real-time surgery of IOIFC. A single dose of 0.05 mg/kg of Indocyanine green was administered prior to surgery. During the procedure, a laparoscopic fluorescence system was used.
  
  
  RESULTS
  IOIFC could be performed in all 45 patients, whereas intraoperative cholangiography could be performed in 42 (93 %). Individual median cost of performing IOFC was cheaper than IOC (13.97 ± 4.3 vs 778.43 ± 0.4 USD) per patient, p = 0.0001). IOFC was faster than IOC (0.71 ± 0.26 vs 7.15 ± 3.76 minutes, p < 0.0001). The cystic duct was identified by IOFC in 44 out of 45 patients (97.77 %).
  
  
  CONCLUSIONS
  IOIFC appears to be a feasible, low-cost, expeditious, useful, and effective imaging modality when performing LC. It is safe, easy to perform and interpret, and does not require a learning curve or X-ray. It can be used for real time surgery to delineate the extrahepatic biliary structures.
authors.affiliation: Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Dip
authors.forename: Mayank
authors.initials: M
authors.lastname: Roy
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lo Menzo
authors.forename: Conrad
authors.initials: C
authors.lastname: Simpfendorfer
authors.forename: Samuel
authors.initials: S
authors.lastname: Szomstein
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D002758:Cholangiography / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D004396:Coloring Agents; D003365:Costs and Cost Analysis; D003549:Cystic Duct / Q000000981:diagnostic imaging; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green