Fluorescent Cholangiography in Laparoscopic Cholecystectomy: the Initial Canadian Experience

Greg Bodie, MD, FRCSC, Geoffrey Chow, MD, Jack Chiu, MD, FRCSC, Mark Meloche, MD, FRCSC, Garth Warnock, MD, MSc, FRCSC, Adam Meneghetti, MD, MHSc, FRCSC, Neely Panton, MBBS, FRCSC, FACS. University of British Columbia

Introduction: Laparoscopic cholecystectomy is the most commonly performed general surgical procedure worldwide.  Bile duct injury rates have not decreased despite increased experience and training with this procedure. Laparoscopic fluorescent cholangiography using Indocyanine Green (ICG) for real-time intraoperative near infrared (NIR) imaging of the extrahepatic biliary system has potential to help identify anatomy and may possibly decrease rates of inadvertent biliary injury.  Here we present the initial Canadian experience with this technique.

Method: An objective analysis of NIR imaging during elective cholecystectomy in Canada was performed.  Patient demographics, intraoperative details, and subjective surgeon data were recorded.  The primary endpoint was to identify real-time rates of cystic and common bile duct identification.  Survey questions were obtained regarding the functionality, use, and perceived benefit of the technology.

Results: NIR imaging with ICG cholangiography was used in 21 initial cases. Patient characteristics showed an average age of 52, BMI of 30, ASA class 2. The average operative time with 79 +/- 31 minutes.  The cystic duct, CBD, and CHD were visualized with NIR in 86%, 67%, and 38% of cases respectively.  Use of fluorescent cholangiography incorporated smoothly into the operation in 83% of cases, and facilitated identification of anatomy in a majority of cases.  There were no adverse reactions or complications related to the technology.

Conclusions: Fluorescent cholangiography allows for non-invasive real time visualization of the extra-hepatic biliary tree.  This technology has not increased operative times and facilitates obtaining a critical view of safety. This technology has received positive feedback in this initial Canadian use and may be a durable adjunct for laparoscopic surgery.