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Introduction:We looked at the reasons why fluorescent cholangiography (FC) should be used routinely in laparoscopic cholecystectomy (LC). Method: A single dose of 0.05 mg/kg of Indocyanin Green (ICG) was administered intravenously one hour prior to the surgery to perform fluorescent cholangiograhy. Results: FC could be performed in all 45 (100%) patients whereas intra-operative cholangiography (IOC) could be performed in 42 out of 45 (93%) patients (p < 0.078). Individual median cost of performing FC was cheaper than IOC (13.97 ± 4.3 vs 778.43 ± 0.4 US dollars per patient, p = 0.0001). The mean operative time was 64.95 ± 17.43 minutes. FC was faster than IOC (0.71 ± 0.26 vs 7.15 ± 3.76 minutes, p < 0.0001). The cystic duct was identified by FC in 44 out of 45 patients (97.77 %). The residents were able to identify the extrahepatic structures in all 45 cases (100%) with FC. No complications were detected related to surgery and the use of FC. Learning curve was not necessary to identify structures using FC. X-ray leads were only used for IOC. FC could be performed by all residents at different level of training in 100% of the cases. Smooth dissection, transection and resection could be safely performed in 45 cases (100%). Conclusion: Fluorescent cholangiography seems to be feasible, cheap, expeditious, useful, an effective teaching tool, safe, no learning curve is necessary, does not require x-ray and easy to perform. It can be used for real time surgery to delineate the extrahepatic biliary structures.Background: Objective of this study is to compare rates of pancreatic fistulas and complications following the Whipple operation between pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG).Methods: 98 patients undergoing Whipple resection were randomized to either PG (48) or PJ (50) reconstruction. T-test and Chi-square tests were used for intention to treat data analysis. Logistic regression was used to measure the influence of surgical technique, preoperative ASA score and soft pancreatic gland on overall complications, severe post operative complications and overall fistula rates. Results: The rate of pancreatic fistula formation was 18% (Grade A = 6%, B = 10%, C = 2%) in the PJ arm and 25% (Grade A = 8%, B = 13%, C = 4%) in the PG arm, p = 0.399. The rate of postoperative complications was 48% (Clavien 1 = 14%, 2 = 36%, 3 = 10%, 4 = 0%, 5 = 2%) in the PJ and 58% (Clavien 1 = 21%, 2 = 38%, 3 = 25%, 4 = 6%, 5 = 4%) in the PG arm, p = 0.306. There was a significant difference in severe complications (Clavien 3-5) with 12% in the PJ and 31% in the PG arm, p = 0.02. In the multivariate analysis randomization (together with ASA) was only predictive of severe complications (OR 0.10, p < 0.005 for randomization to PJ reconstruction; OR 11.58, p < 0.05 for ASA 2 and OR 30.89, p < 0.05 for ASA 3 compared to ASA 1). Conclusion: Results of the study suggest that while there are no overall differences in rates of pancreatic leak/fistula and overall complications between PG and PJ arms, pancreaticogastrostomy is associ...

Methods: A retrospective review of consecutive patients undergoing laparoscopic liver resection between 2001 and 2017 was performed. Results: A total of 1,062 patients underwent MILR. There were 664 females (63%) and 398 males (37%), with a mean age of 58 years (range:17e94), BMI of 29 kg/m2 (range:16e 61), and ASA score of 2.6. The approach was pure laparoscopic in 724 (68%) patients, hand-assisted 134 (13%), hybrid 130 (12%), and robotic 74 (7%). Laparoscopic major hepatectomy (right or left lobectomy) was done in 91/1,062 (9%) cases. Indication for resection was malignancy in 413/ 1,062 (39%) of cases (HCC 38%, mCRC 37%, ICC 6%, NET 5%, Other 14%), or symptomatic benign lesions in the rest. OR time, pRBC transfusion, use of pure laparoscopic approach, and post-op complications all statistically improved over time (Table). Seventy-seven (7.2%) patients developed complications (cardiopulmonary in 22, bile leak in 6, post-op bleeding in 6, intra-abdominal abscess in 5, thromboembolism in 6, and ileus in 8). Unplanned openconversion rate was 2.5% and did not change during periods. Average hospital length of stay was 2.8 days. Ninety-day mortality rate was 4/1,062 patients (0.4%). Conclusion: To our knowledge, this is the largest singlecenter series of laparoscopic liver resection reported worldwide. MILR results in excellent surgical outcomes and low overall complication rates. Surgical performance improved and peri-operative morbidity decreased with greater experience over time.