title: Visualizing biliary tracts with isosulphan blue to prevent injury during laparoscopic cholecystectomy: a preliminary cadaveric study.
abstract: BACKGROUND
  Bile duct injury (BDI) as a complication of laparoscopic cholecystectomy may result in biliary cirrhosis with a high morbidity-mortality rate. Recurrent invasive procedures may be required for the optimum management. The most frequent causative factor in BDI is anatomical misidentification, particularly by inexperienced surgeons. Direct coloration of the cystic duct, bile duct, and gallbladder may decrease biliary tract injury.
  
  
  METHODS
  This study was conducted during 10 standard, fresh cadaver autopsies at the Council of Forensic Medicine, Istanbul. Following needle puncture of the gallbladder fundus and aspiration of the bile content, identical quantities of isosulphan blue were injected into the gallbladder to visualize the biliary tract.
  
  
  RESULTS
  Of the ten fresh cadavers, three were males and seven were females; the mean age at death was 43 years (range 22-76 years). Successful visualization of the colored biliary tract, encompassing the gallbladder, cystic duct, and bile duct, was achieved in all of the cadavers.
  
  
  CONCLUSIONS
  Visualization of the biliary tract may reduce the risk associated with dissection of Calot's triangle. Surgical BDI risk following anatomical misidentification could be reduced by intraoperative injection of isosulphan blue; further studies are required to validate the clinical utility of this technique.
authors.affiliation: Department of General Surgery, Faculty of Medicine, Sakarya University, Adnan Menderes Caddesi, Saglik Sokak No:193, 54100, Sakarya, Turkey. veliorhan@hotmail.com.
authors.forename: Orhan Veli
authors.initials: OV
authors.lastname: Ozkan
authors.affiliation: Department of General Surgery, Research and Educational Hospital, Sakarya University, 54100, Sakarya, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Yagmurkaya
authors.affiliation: Council of Forensic Medicine, Bahçelievler, 34196, Istanbul, Turkey.
authors.forename: Muhammed Feyzi
authors.initials: MF
authors.lastname: Sahin
authors.affiliation: Council of Forensic Medicine, Bahçelievler, 34196, Istanbul, Turkey.
authors.forename: Ahmet Selcuk
authors.initials: AS
authors.lastname: Gurler
authors.affiliation: Department of Forensic Medicine, Faculty of Medicine, Dumlupınar University, 43266, Sakarya, Turkey.
authors.forename: Hudaverdi
authors.initials: H
authors.lastname: Kucuker
mesh_terms: D000328:Adult; D000368:Aged; D001659:Biliary Tract / Q000033:anatomy & histology*; D002102:Cadaver; D017081:Cholecystectomy, Laparoscopic; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012394:Rosaniline Dyes; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue
keywords: Bile duct injury prevention; Isosulphan blue injection technique; Laparoscopic cholecystectomy complications