Abstract
Background
Laparoscopic cholecystectomy (LC) is one of the most commonly performed laparoscopic procedures. Bile duct injury is a rare but serious complication during this procedure, mostly caused by misidentification of the extrahepatic bile duct anatomy. Intraoperative cholangiography may be helpful to reduce the risk of bile duct injury; however, this is not a common procedure worldwide. Near-infrared fluorescence cholangiography (NIRFC) using indocyanine green (ICG) is a promising alternative for the identification of the biliary tree. This prospective observational study was designed to assess the feasibility and image quality of intermittent NIRFC during LC, using a newly developed laparoscopic fluorescence system.
Methods
Consecutive patients undergoing elective LC were included and received a single intravenous injection of ICG directly after induction of anesthesia. During dissection of the base of the gallbladder and the cystic duct, the extrahepatic bile ducts were visualized by using a dedicated laparoscope, which offers both conventional state-of-the-art imaging and fluorescence imaging. Intraoperative recognition of the biliary structures was registered at set time points, as well as the establishment of the critical view of safety.
Results
Fifteen patients were included between December 2011 and May 2012. ICG was visible in the liver and bile ducts within 20 min after intravenous administration and remained for approximately 2 h, using the fluorescence mode of the laparoscope. The common bile duct and cystic duct could be clearly identified at an early stage of the operation and, more important, significantly earlier than with the conventional camera mode. No per- or postoperative complications occurred as a consequence of ICG use.
Conclusions
Intermittent fluorescence imaging using a newly developed laparoscope and preoperative administration of ICG seems a useful aid in accelerating visualization of the extrahepatic bile ducts during laparoscopic cholecystectomy.
Similar content being viewed by others
References
Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T (2003) Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 289:1639–1644
Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, Knuiman MW, Sheiner HJ, Edis A (1999) Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 229:449–457
Nuzzo G, Giuliante F, Giovannini I, Ardito F, D’Acapito F, Vellone M, Murazio M, Capelli G (2005) Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56,591 cholecystectomies. Arch Surg 140:986–992
Waage A, Nilsson M (2006) Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish inpatient registry. Arch Surg 141:1207–1213
Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, Hunter JG (2003) Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 237:460–469
Buddingh KT, Nieuwenhuijs VB, van Buuren L, Hulscher JB, de Jong JS, van Dam GM (2011) Intraoperative assessment of biliary anatomy for prevention of bile duct injury: a review of current and future patient safety interventions. Surg Endosc 25:2449–2461
Ford JA, Soop M, Du J, Loveday BP, Rodgers M (2012) Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg 99:160–167
Agarwal BB (2009) Patient safety in laparoscopic cholecystectomy. Arch Surg 144:979 author reply 979
Ankersmit M, van der Pas MH, van Dam DA, Meijerink WJ (2011) Near infrared fluorescence lymphatic laparoscopy of the colon and mesocolon. Colorectal Dis 13(Suppl 7):70–73
Mieog JS, Troyan SL, Hutteman M, Donohoe KJ, van der Vorst JR, Stockdale A, Liefers GJ, Choi HS, Gibbs-Strauss SL, Putter H, Gioux S, Kuppen PJ, Ashitate Y, Lowik CW, Smit VT, Oketokoun R, Ngo LH, van de Velde CJ, Frangioni JV, Vahrmeijer AL (2011) Toward optimization of imaging system and lymphatic tracer for near-infrared fluorescent sentinel lymph node mapping in breast cancer. Ann Surg Oncol 18:2483–2491
van der Vorst JR, Hutteman M, Gaarenstroom KN, Peters AA, Mieog JS, Schaafsma BE, Kuppen PJ, Frangioni JV, van de Velde CJ, Vahrmeijer AL (2011) Optimization of near-infrared fluorescent sentinel lymph node mapping in cervical cancer patients. Int J Gynecol Cancer 21:1472–1478
Hutteman M, van der Vorst JR, Gaarenstroom KN, Peters AA, Mieog JS, Schaafsma BE, Lowik CW, Frangioni JV, van de Velde CJ, Vahrmeijer AL (2012) Optimization of near-infrared fluorescent sentinel lymph node mapping for vulvar cancer. Am J Obstet Gynecol 206(89):e81–85
Themelis G, Yoo JS, Soh KS, Schulz R, Ntziachristos V (2009) Real-time intraoperative fluorescence imaging system using light-absorption correction. J Biomed Opt 14:064012
Lange JF, Stassen LPS (2006) Best practice in verband met de techniek van laparoscopische cholecystectomie (Critical View of Safety [CVS] in 7 stappen). Werkgroep Endoscopische Chirurgie van de Nederlandse vereniging voor Heelkunde, http://wwwheelkundenl/uploads/_6/re/_6reZZkgrYUAuCG6uvcN-A/richtlijn_galsteenpdf
Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125
Kuwada T (2005) Highlights of the Society of American Gastrointestinal and Endoscopic Surgeons 2005, Annual Meeting april 13-16, 2005; Ft Lauderdale, Florida. Medscape General Surgery: Conference reports, http://wwwmedscapecom/viewarticle/506432
Johnston EV, Anson BJ (1952) Variations in the formation and vascular relationships of the bile ducts. Surg Gynecol Obstet 94:669–686
Ishizawa T, Bandai Y, Ijichi M, Kaneko J, Hasegawa K, Kokudo N (2010) Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy. Br J Surg 97:1369–1377
Ishizawa T, Kaneko J, Inoue Y, Takemura N, Seyama Y, Aoki T, Beck Y, Sugawara Y, Hasegawa K, Harada N, Ijichi M, Kusaka K, Shibasaki M, Bandai Y, Kokudo N (2011) Application of fluorescent cholangiography to single-incision laparoscopic cholecystectomy. Surg Endosc 25:2631–2636
Tagaya N, Shimoda M, Kato M, Nakagawa A, Abe A, Iwasaki Y, Oishi H, Shirotani N, Kubota K (2010) Intraoperative exploration of biliary anatomy using fluorescence imaging of indocyanine green in experimental and clinical cholecystectomies. J Hepatobiliary Pancreat Sci 17:595–600
Ashitate Y, Stockdale A, Choi HS, Laurence RG, Frangioni JV (2011) Real-time simultaneous near-infrared fluorescence imaging of bile duct and arterial anatomy. J Surg Res 176(1):7–13
Acknowledgments
The authors thank Karl Storz GmbH & Co. KG (Tuttlingen, Germany) for providing the laparoscopic fluorescence imaging system and for technical assistance during the study. Furthermore, we acknowledge the surgeons and resident surgeons who performed the laparoscopic cholecystectomies in this study. This study was partly presented in an oral presentation during the 20th International Congress of the EAES in Brussels, June 20-23 2012.
Disclosures
R.M. Schols, N.D. Bouvy, A.A.M. Masclee, R.M. van Dam, C.H.C. Dejong, and L.P.S. Stassen have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schols, R.M., Bouvy, N.D., Masclee, A.A.M. et al. Fluorescence cholangiography during laparoscopic cholecystectomy: a feasibility study on early biliary tract delineation. Surg Endosc 27, 1530–1536 (2013). https://doi.org/10.1007/s00464-012-2635-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2635-3