Ten Reasons to Use Fluorescent Cholangiography in Laparoscopic Cholecystectomy

Fernando Dip, MD, Mayank Roy, MD, Emanuele Lo Menzo, MD, Conrad Simpfendorfer, MD, Samuel Szomstein, MD, Raul Rosenthal, MD. Cleveland Clinic Florida.

Background: Intra-operative fluorescent cholangiography (FC) has been described as a novel tool to identify the extrahepatic biliary anatomy during laparosocpic cholecystectomy (LC). We investigated the reasons why FC should be used routinely in LC.

Methods: We analyzed feasibility, cost, time, usefulness, teaching tool, safety, learning curve, x-ray exposure, complexity, and real time surgery of FC in 45 patients who underwent LC.

A single dose of 0.05 mg/kg of Indocyanin Green (ICG) (Akorn, Florida, USA) was administered intravenously one hour prior to the surgery. During the procedure, a xenon/infrared light source with charge-coupled device camera was used.

Results: FC could be performed satisfactorily in all 45 patients (100% of the cases). Individual mean cost was 14.1 ± 4.43 US dollars per patient (0.16 US dollars ICG/kg). The mean operative time was 64.95 min ± 17.43. FC took a mean time of 0.71 ± 0.26 min. The cystic duct was identified with FC in 44 out of 45 patients (97.7 %). The common hepatic duct was seen clearly in 27 of 45 patients (60%), and the common bile duct in 36 of 45(80%) patients. No allergic reactions were reported related to the use of ICG. No learning curve was necessary to use FC. X-ray was used only while performing IOC. The dissection could be performed during infrared mode of FC. Surgeons reported FC to be an effective teaching tool in 100% of the cases.

Conclusion: Fluorescent cholangiography seems to be feasible, inexpensive, expeditious, useful, and an effective teaching tool. It is safe, no learning curve is necessary, does not require x-ray, and it is easy to perform. It can be used for real time surgery to delineate the extrahepatic biliary structures. FC seems to be a tool which can be used routinely in LC.

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