Firefly Utiization in Robotic Cholecystectomy: Safer for the Patient?

Eric L DuBois, MD, Stan C Hewlett, MD, FACS. Baptist Health System

INTRODUCTION: Robotic surgery has increasingly been adopted by general surgeons and provides a viable safer option to surgeries traditionally performed laparoscopically. With the increased costs of robotics, a benefit over laparoscopic surgery needs to be shown to justify the increased costs. Patient safety is a practical justification for the increased costs of robotics. With the advancements in robotics, new technology such as firefly can aid the surgeon during surgery and provide information previously unavailable.

METHODS AND PROCEDURES: A survey was created for general surgeons to fill out immediately following a robotic cholecystectomy with or without firefly. The survey collected data regarding operative time, use of firefly including dosage, preoperative timing, and the structures identified both before and after dissection with white light and with firefly. The survey results were collected in a database for statistical analysis. The survey was predominately distributed to general surgeons in the southeast United States.

RESULTS: Firefly consistently aided the surgeons in identification of critical structures both before and after dissection. Surgeon’s consistently identified more structures with firefly as well. A difference in operative time with and without firefly was not found to be statistically significant. Overall, in all the cases submitted, surgeons felt that firefly made the operation safer for the patient 78% of the time.

CONCLUSIONS: Laparoscopic Cholecystectomy is one of the most common surgeries performed today. While Robotic Cholecystectomy will not replace it any time soon, it is another tool in the surgeon’s armamentarium and with the aid of firefly makes it potentially safer for the patient as well.