Intra-operative Fluorescent Cholangiography Using Indocyanin Green for Robotic Single Site Cholecystectomy

Nicolas N Buchs, MD, Francois Pugin, MD, Franceso Volonte, MD, Pascal Bucher, MD, Eduardo Schiffer, MD, Philippe Morel, MD PhD. Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Switzerland, Department of Anesthesiology, University Hospital of Geneva, Switzerland

Introduction: Fluorescent imaging with Indocyanin green (ICG) might be a non-ionizing alternative to conventional intra-operative cholangiography for the visualization of biliary anatomy without time consuming undocking the robotic system.
Video: The video shows a robotic single incision cholecystectomy using fluorescent imaging with ICG to visualize the biliary anatomy in a 42 year old male patient with a cholecystolithiasis.
Results: The video demonstrates the feasibility of using fluorescent imaging with ICG for robotic single incision cholecystectomy for imaging the biliary system. Common hepatic duct, cystic duct and common bile duct were visualized using fluorescence before they were visible in conventional white light.
Conclusions: Fluorescent cholangiography seems to enable real-time identification of the biliary anatomy using a near infrared camera integrated to the da Vinci Surgical System. Its routine clinical use still needs further larger studies to define the clear indications.