Laparoscopic Cholecystectomy: Postoperative Imaging

Thurley, Peter; Dhingsa, Rajpal

doi:10.2214/ajr.07.3485

Cited by 79 publications

(50 citation statements)

References 67 publications

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“…9 However, and despite the widespread implementation of CVS, recent literature suggests that bile duct injury still occurs in 0.26% to 0.7% of procedures. 10-15 In addition, conversion to an open procedure is indicated in cases where CVS cannot be reached, with reported conversion-to-open rates in LC presently around 2.6% to 10%. 16-18 Conversion is often due to unclear (biliary) anatomy associated with a wider range of conditions including acute cholecystitis, acute biliary pancreatitis, bleeding in Calot’s triangle, fibrotic shrunken gallbladders due to previous infection, gallstones in Hartmann’s pouch, a short cystic duct, Mirizzi’s syndrome, or abnormal biliary anatomy.…”

Section: Introductionmentioning

confidence: 99%

Fluorescent Imaging With Indocyanine Green During Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury

et al. 2017

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Background. Although rare, injury to the common bile duct (CBD) during laparoscopic cholecystectomy (LC) can be reduced by better intraoperative visualization of the cystic duct (CD) and CBD. The aim of this study was to establish the efficacy of early visualization of the CD and the added value of CBD identification, using near-infrared (NIR) light and the fluorescent agent indocyanine green (ICG), in patients at increased risk of bile duct injury. Materials and Methods. Patients diagnosed with complicated cholecystitis and scheduled for LC were included. The CBD and CD were visualized with NIR light before and during dissection of the liver hilus and at critical view of safety (CVS). Results. Of the 20 patients originally included, 2 were later excluded due to conversion. In 6 of 18 patients, the CD was visualized early during dissection and prior to imaging with conventional white light. The CBD was additionally visualized with ICG-NIR in 7 of 18 patients. In 1 patient, conversion was prevented due to detection of the CD and CBD with ICG-NIR. Conclusions. Early visualization of the CD or additional identification of the CBD using ICG-NIR in patients with complicated cholecystolithiasis can be helpful in preventing CBD injury. Future studies should attempt to establish the optimal dosage and time frame for ICG administration and bile duct visualization with respect to different gallbladder pathologies.

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Section: Introductionmentioning

confidence: 99%

Fluorescent Imaging With Indocyanine Green During Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury

et al. 2017

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“…3,9 The reported occurrence rate of bile duct injury ranged from 0.4% to 4%. 10 It could prolong the hospital stay, and result in cholangitis and biliary cirrhosis. Hepatic failure could be the lethal complication after bile duct injury.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared with Traditional Laparoscopic Cholecystectomy: Erratum

2017

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Abstract:The study aimed to compare the application values of endoscopic-laparoscopic cholecystolithotomy (ELC) and laparoscopic cholecystectomy (LC) for patients with cholecystolithiasis. It did a retrospective analysis of 107 patients with cholecystolithiasis who underwent ELC and 144 patients with cholecystolithiasis who underwent LC. There is no significant difference in operating time and expenses when comparing ELC with LC (P > 0.05). ELC showed significantly less blood loss during operation compared with LC (P < 0.01). Shortened exhaust time (P < 0.05) and hospital stay (P < 0.01) were present in patients who underwent ELC. Moreover, ELC showed decreased occurrence rate of dyspepsia and diarrhea in comparison with LC (P < 0.01). The stone recurrence rate of ELC was 16.67%. ELC decreased the recurrence of stone in common bile duct in comparison with LC. The contractile function of gallbladder was close to normal (P < 0.05), and the thickness of gallbladder wall significantly decreased (P < 0.001). Patients who underwent ELC showed less digestive symptom, good recovery, and low stone recurrence compared with those who underwent LC.

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“…Second, we hypothesized that particularly for cases of complicated cholecystolithiasis such as cholecystitis, biliary pancreatitis, surgery after endoscopic retrograde cholangiopancreatography, or percutaneous gallbladder drainage with The rate of bile duct injuries in single-incision laparoscopic surgery cholecystectomy is higher than in laparoscopic cholecystectomy: 0.7% versus 0.26%-0.6%, respectively. 8,39 This might be attributable to the different angle in which the surgical field is approximated or due to different positioning and introduction of a decreased number of trocars than in conventional laparoscopic cholecystectomy. Differences in visualization might impede or delay recognition of the extrahepatic bile ducts and increase the risk of iatrogenic bile duct injury.…”

Section: Discussionmentioning

confidence: 99%

“…2 However, despite an initial decrease in bile duct injuries with the introduction of CVS, current literature suggests that bile duct injuries are still in the 0.26%-0.6% range. [3][4][5][6][7][8] Although this complication is rare, a patient with a common bile duct (CBD) injury is likely to have re-interventions, prolonged hospital admission, and a decreased quality of life and is faced with a 5%-9% mortality risk. [9][10][11][12][13] The 2011 consensus meeting of the European Association for Endoscopic Surgery in Turin, Italy, confirmed that prevention of bile duct injury remains a priority in the improvement of laparoscopic cholecystectomies.…”

Section: Introductionmentioning

confidence: 99%

Comparing Near-Infrared Imaging with Indocyanine Green to Conventional Imaging During Laparoscopic Cholecystectomy: A Prospective Crossover Study

Dam

Ankersmit

Ven

et al. 2015

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: The aim of this study was to test and validate a novel noninvasive method for intraoperative visualization of extrahepatic bile ducts during laparoscopic cholecystectomy. Injury to the common bile duct (CBD) is a rare but major complication of laparoscopic cholecystectomy. Most injuries occur when anatomy is unclear due to the presence of anatomic variations, acute inflammation, or adhesions. Patients and Methods: Thirty patients were included, and each received an intravenous injection of 0.05 mg/kg of indocyanine green (ICG) (ICG-Pulsion Ò ; PULSION Medical Systems AG, Munich, Germany) prior to the start of surgery. Laparoscopic cholecystectomy was performed according to standard procedures. The CBD and cystic duct (CD) were visualized before and during dissection of the liver hilus using a conventional laparoscopic camera and a recently developed near-infrared (NIR) camera (Olympus, Tokyo, Japan). Results: Using ICG-NIR, the CBD and CD could be visualized 11 minutes (P = .008) and 8.6 minutes (P = .001) earlier than with a conventional camera. Both early (20/30 patients) and late (26/30 patients) identification of the CBD with ICG-NIR was significantly more frequent compared with conventional images (2/30 and 10/30, respectively; P < .001). One postoperative bilioma required re-admission and endoscopic retrograde cholangiopancreatography with stent placement. Conclusions: Identification of the CBD and CD using a low dose of ICG and the NIR camera was both faster and more frequent compared with conventional laparoscopic images during elective laparoscopic cholecystectomy.

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Laparoscopic Cholecystectomy: Postoperative Imaging

Abstract: Laparoscopic cholecystectomy is a commonly performed surgical procedure and radiologists are often called on to identify or rule out postoperative complications. In such cases, the correct diagnosis is crucial in optimizing patient management.

Cited by 79 publications

References 67 publications

Fluorescent Imaging With Indocyanine Green During Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury

Fluorescent Imaging With Indocyanine Green During Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury

Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared with Traditional Laparoscopic Cholecystectomy: Erratum

Comparing Near-Infrared Imaging with Indocyanine Green to Conventional Imaging During Laparoscopic Cholecystectomy: A Prospective Crossover Study

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