J Gastrointest Surg DOI 10.1007/s11605-014-2560-y
ORIGINAL ARTICLE
Effectiveness of Intraoperative Cholangiography Using Indocyanine Green (Versus Contrast Fluid) for the Correct Assessment of Extrahepatic Bile Ducts During Day-Case Laparoscopic Cholecystectomy F. Prevot & L. Rebibo & C. Cosse & F. Browet & C. Sabbagh & J.-M. Regimbeau
Received: 6 December 2013 / Accepted: 27 May 2014 # 2014 The Society for Surgery of the Alimentary Tract
Abstract Introduction 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. Materials and 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. Conclusion 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. Keywords Laparoscopic cholecystectomy . Intraoperative cholangiography . Indocyanine green . Fluorescent cholangiography . Near-infrared fluorescence imaging
Introduction Laparoscopic cholecystectomy is a frequent procedure, with over 750,000 such operations performed per year in the USA.1 However, inadvertent bile duct injury (BDI) due to misidentification of the biliary anatomy occurs in between 0.2 and F. Prevot : L. Rebibo : C. Cosse : F. Browet : C. Sabbagh : J.
ORIGINAL ARTICLE
Effectiveness of Intraoperative Cholangiography Using Indocyanine Green (Versus Contrast Fluid) for the Correct Assessment of Extrahepatic Bile Ducts During Day-Case Laparoscopic Cholecystectomy F. Prevot & L. Rebibo & C. Cosse & F. Browet & C. Sabbagh & J.-M. Regimbeau
Received: 6 December 2013 / Accepted: 27 May 2014 # 2014 The Society for Surgery of the Alimentary Tract
Abstract Introduction 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. Materials and 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. Conclusion 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. Keywords Laparoscopic cholecystectomy . Intraoperative cholangiography . Indocyanine green . Fluorescent cholangiography . Near-infrared fluorescence imaging
Introduction Laparoscopic cholecystectomy is a frequent procedure, with over 750,000 such operations performed per year in the USA.1 However, inadvertent bile duct injury (BDI) due to misidentification of the biliary anatomy occurs in between 0.2 and F. Prevot : L. Rebibo : C. Cosse : F. Browet : C. Sabbagh : J.
