Techniques of Fluorescence Cholangiography During Laparoscopic Cholecystectomy for Better Delineation of the Bile Duct Anatomy

Kono, Yoshiharu; Ishizawa, Takeaki; Tani, Kazuhide; Harada, Nobuhiro; Kaneko, Junichi; Saiura, Akio; Bandai, Yasutsugu; Kokudo, Norihiro

doi:10.1097/md.0000000000001005

Cited by 89 publications

(87 citation statements)

References 29 publications

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“…The majority of previous investigations were small, prospective non‐controlled and controlled studies, and these indicated that the ability of fluorescence cholangiography to visualize the critical junction was equal to that of X‐ray cholangiography. A recent RCT including 639 patients compared fluorescence cholangiography with white light (normal vision) and not with X‐ray cholangiography as the standard.…”

Section: Discussionmentioning

confidence: 99%

Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

Lehrskov

Westen²,

Larsen³

et al. 2020

British Journal of Surgery

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Background: Safe laparoscopic cholecystectomy may necessitate biliary imaging, and non-invasive fluorescence cholangiography may have advantages over contrast X-ray cholangiography. This trial compared fluorescence and X-ray cholangiography for visualization of the critical junction between the cystic, common hepatic and common bile ducts. Methods: This non-inferiority blinded RCT included patients who had either intraoperative fluorescence cholangiography using 0⋅05 mg/kg indocyanine green or X-ray cholangiography during elective laparoscopic cholecystectomy.Results: Between March 2015 and August 2018, a total of 120 patients were randomized (60 in each group). There were no drop-outs and 30-day follow-up data were available for all patients. In intention-to-treat analysis, there was no difference between the fluorescence and X-ray cholangiography groups in ability to visualize the critical junction (49 of 60 versus 51 of 60 respectively; P = 0⋅230). Fluorescence cholangiography was faster by a few minutes: median 2⋅0 (range 0⋅5-5⋅0) versus 4⋅8 (1⋅3-17⋅6) min (P < 0⋅001).Conclusion: Fluorescence cholangiography was confirmed to be non-inferior to X-ray cholangiography in visualizing the critical junction during laparoscopic cholecystectomy. Registration number: NCT02344654 (http://www.clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 99%

Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

Lehrskov

Westen²,

Larsen³

et al. 2020

British Journal of Surgery

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“…Misidentification, with a reported incidence ranging from 0.08% to 1.5%, is accomplished with a morbidity up to 21% and high healthcare costs . The use of intravenously ICG injection for identification of the bile ducts with NIR fluorescence cholangiography was evaluated in 30 studies, which showed a pooled cystic duct identification in 1019/1050 (97%) patients . Although, the biliary ducts could be very well visualized, the diminished visualization of the bile ducts in minority of the patients, could be caused by inflammatory tissue or fatty peritoneum (in obese patients) covering the biliary ducts, which hampered the penetration of NIR light .…”

Section: Visualization Of Vital Structuresmentioning

confidence: 99%

A practical guide for the use of indocyanine green and methylene blue in fluorescence‐guided abdominal surgery

Manen

Handgraaf

Diana

et al. 2018

Journal of Surgical Oncology

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251

178

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Near‐infrared (NIR) fluorescence imaging is gaining clinical acceptance over the last years and has been used for detection of lymph nodes, several tumor types, vital structures and tissue perfusion. This review focuses on NIR fluorescence imaging with indocyanine green and methylene blue for different clinical applications in abdominal surgery with an emphasis on oncology, based on a systematic literature search. Furthermore, practical information on doses, injection times, and intraoperative use are provided.

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“…It is possible that the laparoscope was at different distances from the ureter, resulting in different amounts of fluorescence being detected and influencing the TBR. Kono and colleagues19 reported that the signal contrast on fluorescence images of bile duct samples differed significantly between the laparoscopic imaging systems, and tended to decrease as the laparoscope–target distance increased and porcine tissues covering the samples became thicker.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a novel dye for near‐infrared fluorescence delineation of the ureters during laparoscopy

et al. 2018

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BackgroundIatrogenic ureteric injury remains a risk in laparoscopic pelvic procedures. Near‐infrared fluorescence (NIRF) imaging is a promising new technique for enhanced intraoperative visualization of anatomical structures that could improve the safety of laparoscopic surgery. A new dye, IRDye® 800‐BK, has been developed for intraoperative visualization of the ureters using NIRF. The present study was a first evaluation of the performance of IRDye® 800‐BK for ureteric imaging during NIRF laparoscopy.MethodsThis study consisted of three parts: real‐time in vivo NIRF imaging using IRDye® 800‐BK in pigs during laparoscopic surgery, ex vivo NIRF imaging of freshly explanted pig ureters and ex vivo NIRF imaging of explanted human ureters.ResultsIn all animals, both left and right ureters were visualized throughout the laparoscopic procedure for 120 min, with the best results at a dose of 0·15 mg dye per kg bodyweight. NIRF imaging was successful in all human and porcine ureters studied, with a range of dye concentrations.ConclusionNIRF imaging of the ureters using IRDye® 800‐BK was used successfully both in vivo in a porcine model, and ex vivo in porcine and human ureters.

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Techniques of Fluorescence Cholangiography During Laparoscopic Cholecystectomy for Better Delineation of the Bile Duct Anatomy

Abstract: Supplemental Digital Content is available in the text

Cited by 89 publications

References 29 publications

Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

A practical guide for the use of indocyanine green and methylene blue in fluorescence‐guided abdominal surgery

Evaluation of a novel dye for near‐infrared fluorescence delineation of the ureters during laparoscopy

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