Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy

Abstract

Fluorescent cholangiography enables real-time identification of biliary anatomy during dissection of Calot's triangle. This simple technique may become standard practice for avoiding bile duct injury during laparoscopic cholecystectomy, replacing radiographic cholangiography.

Pure Laparoscopic Full-Left Living Donor Hepatectomy for Calculated Small-for-Size LDLT in Adults: Proof of Concept

“…One possibility could be the use of indocyanine green dye with a fluorescent imaging system. Unfortunately, the images are still biased by different factors that interfere with the uptake of contrast in the blood vessels and in the biliary ducts (20). In conclusion, our small experience proves the feasibility of laparoscopic full left liver procurement for A2LDLT.…”

Exclusion criteria for assuring safety of single-incision laparoscopic cholecystectomy

“…In contrast, our indication criteria for SILC are stricter than those used in the previous series in terms of restrictions in age and BMI. In particular, routine use of preoperative cholangiographic images to evaluate bile duct anatomy may be a debatable issue, but we believe that preoperative cholangiography and/or intraoperative fluorescence cholangiography (18,19) is essential for reducing risk of bile duct injury especially in patients undergoing SILC. As singleincision surgery techniques advance, indications of SILC can be expanded gradually in future.…”

“…The procedure was performed through Semi-cross method, holding an articulating instrument (Roticulator Endo Grasp; Covidien) with the left hand and a straight instrument with the right hand (15). The triangle of Calot was dissected to reach "critical view of safety" (16), while using fluorescence cholangiography (17)(18)(19)(20) with preoperative and intravenous injection of ICG at any time during the procedures ( Figure 1 and supplementary video 1, http://biosciencetrends. com/docindex.php?year=2015&kanno=6).…”

Robotic Approach to Cholecystectomy

“…Fluorescent image guidance can be used sporadically as verification or in real time. Use of indocyanine green has been repeatedly demonstrated as a safe technique in both laparoscopic and robotic-assisted cholecystectomy, allowing for visualization of the cystic duct, common bile duct and common hepatic duct in 94% or more of cases [39][40][41]. ICG can also be used to visualize the cystic artery if assessed within 45 seconds of an injection of ICG, but may lead to confusion between the vascular and biliary structures.…”