Fluorescent Insicionless Cholangiography as a teaching tool for identification of Calot’s triangleSubtitle: Fluorescent Cholangiography in a residency program

Mayank Roy, MD, Fernando Dip, MD, David Nguyen, MD, Conrad Simpfendorfer, MD, FACS, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul J Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida

Introduction: Intra-operative incisionless Fluorescent cholangiogram (IOIFC) has been demonstrated to be a useful tool to increase the visualization of the Calot’s triangle.  This study evaluates the identification of extra-hepatic biliary structures with xenon and near infrared (NIR) light by medical students and surgery residents. 

Method: A picture with xenon light as well as with NIR light at the same stage of Calot’s triangle dissection was taken from 10 different cases of laparoscopic cholecystectomy (LC). All 20 pictures were organized in a random fashion to remove any imagery bias. 20 students and 20 residents were asked to identify the biliary anatomy.

Results: Medical students were able to accurately identify the cystic duct on an average 33.8% under the xenon light vs 86% under the NIR light (p=0.0001), the common hepatic duct on an average 19% under the xenon light vs 88.5% under the NIR light (p=0.0001) and the junction on an average 24% under xenon light vs 80.5% under the NIR light (p=0.0001). Surgery residents were able to accurately identify the cystic duct on an average 40% under the xenon light vs 99% under the NIR light (p=0.0001), the common hepatic duct on an average 35% under the xenon light vs 96% under the NIR light (p=0.0001) and the junction on an average 24% under the xenon light vs 95.5% under the NIR light (p=0.0001).

Conclusion: For a given reader level, IOIFC increases the visualization of the Calot’s triangle structures when compared to xenon light. IOIFC may be a useful teaching tool in residency programs to teach LC. 

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