Fluorescence versus X-ray cholangiography during laparoscopic cholecystectomy: protocol for a randomised trial

Area of Science:

• Surgical imaging techniques
• Minimally invasive surgery
• Biliary tract anatomy

Background:

• Intraoperative fluorescent cholangiography (IFC) is a novel, non-invasive imaging method for visualizing the extrahepatic biliary tract during laparoscopic cholecystectomy.
• IFC has demonstrated feasibility, speed, and cost-effectiveness.
• Limited data exists on IFC's ability to visualize biliary anatomy.

Purpose of the Study:

• To compare the efficacy of intraoperative fluorescent cholangiography (IFC) with conventional X-ray cholangiography.
• To assess IFC's capability in visualizing key structures of the extrahepatic biliary tract.

Main Methods:

• A non-inferiority study design was employed.
• Patients with complicated gallstone disease were randomized into two groups (n=60 each).
• One group received conventional X-ray cholangiography, while the other received intraoperative fluorescent cholangiography.

Main Results:

• The primary outcome measured was the visualization of the junction between the cystic duct, common hepatic duct, and common bile duct.
• The study aimed to demonstrate non-inferiority of IFC compared to conventional methods.

Conclusions:

• Intraoperative fluorescent cholangiography appears to be as valid as conventional X-ray cholangiography for visualizing critical structures of the extrahepatic biliary tract.
• This finding may support the adoption of IFC for real-time imaging during gallbladder dissection in cholecystectomy.