Fluorescent cholangiography in laparoscopic cholecystectomy : experience in Argentina

Pedro Ferraina, Fernando Dip, Lisandro Alle, Mario Nahmod, Luis Sarotto, Francisco Suarez Anzorena

Sanatorio Anchorena

In Argentina the frequency of laparoscopic cholecystectomies has increased in the last few years. The use of intraoperative methods for the detection of bile ducts such as the intraoperative cholangiography varies within the country but it is a routinely procedure in our workplace. Surgical injuries in bile ducts have remained constant coming to about 0.4%.

This is why we have been looking for an easy alternative to be used sometime in the future to reduce that number.

Since 2011 we have started to perform fluorescent cholangiography with the administration of indocianine green and the ilumination of the abdominal cavity with infrared light in laparoscopic cholecystomies.

Up to now we have performed it on 65 patients. The use of this method seems promising with some clear advantages such as its low cost, real time performance and the possibility to visualize structures previous to their being sectioned.To assess the accuracy of the fluorescent method, the number of patients in whom the structures were visualized before the dissection was considered to be a very positive sign.
After that an ordinary radioscopic cholangiography was performed, and specificity was considered to assess if the structures initially identified as cystic, proximal bile duct were ratified by intraoperative cholangiography. We have been able to visualize in 95 % of the cases the main bile duct and the cyst duct without dissection with fluorescence.
What still needs to be improved, is mainly the technical questions such as the depth for visualization in obese patients or severe or substantially chronic inflammatory stages where the light cannot go through the tissues.

Session: Poster Presentation

Program Number: P355

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