Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy

Area of Science:

• Surgical Innovation
• Medical Imaging
• Gastroenterology

Background:

• Intraoperative cholangiography is recommended to prevent bile duct injury during laparoscopic cholecystectomy.
• Radiographic cholangiography is time-consuming and carries a risk of bile duct injury.
• A novel fluorescent cholangiography technique using indocyanine green (ICG) has been developed.

Purpose of the Study:

• To evaluate the efficacy of fluorescent cholangiography using ICG in delineating biliary anatomy during laparoscopic cholecystectomy.
• To compare fluorescent cholangiography with preoperative cholangiography in identifying biliary structures.
• To assess the potential of fluorescent cholangiography in preventing bile duct injury.

Main Methods:

• 52 patients undergoing laparoscopic cholecystectomy received intravenous ICG (2.5 mg) preoperatively or post-intubation.
• A fluorescent imaging system with a xenon light source and specialized laparoscope was utilized.
• Fluorescent cholangiography was performed during Calot's triangle dissection and compared to preoperative imaging.

Main Results:

• Fluorescent cholangiography successfully delineated the cystic duct in all 52 patients.
• The cystic duct-common hepatic duct junction was visualized pre-dissection in 50 patients.
• All pre-diagnosed accessory bile ducts were identified by fluorescent imaging in eight patients.

Conclusions:

• Fluorescent cholangiography provides real-time identification of biliary anatomy during laparoscopic cholecystectomy.
• This simple technique may become a standard for preventing bile duct injury.
• It has the potential to replace conventional radiographic cholangiography.