Safe Cholecistectomy. Fluorescent Cholangiography

Pedro Ferraina, PHD, Fernando Dip, MD, Alle Lisandro, MD, Mario Nahmod, Luis Sarotto, MD. Sanatorio Anchorena

 

The usefulness of fluorescent cholangiography for the purpose of achieving accuracy in laparoscopic surgery. Our concern over accuracy in laparoscopic surgery led us to prepare this video to demonstrate the usefulness of fluorescent cholangiography.

Four cases will be shown, three patients suffering from symptomatic biliary lithiasis and one patient suffering cholecystitis.
In the first case, the patient is a 36 years old woman who suffers from simple bile lythiasis without associated alterations. The usual laparoscopy is performed identifying the Calot´s triangle. A pedal is used to change the light and obtain the fluorescent image that allows the visualization of the choledochus duct, the hepatic duct, the cystic choledocyanine junction and the bile cystic junction. The lifting of the liver facilitates the visualization of the divisions of the hepatic ducts and the anatomic identification of the beginning of the bile duct. After performing the conventional fluoroscopic cholangiography, we clipped and sectioned the cyst in a fluorescent way.
In the second case, the patient is a 30 years old man who suffers from biliary colic occurring repetitively by vesicular lithiasis.
After compressing the bassinet and exposing the field under infrared vision, we could anatomically identify a beaded cyst and a choledochus in parallel without manipulating the dissection of the hilum.
After adjusting good traction , and carrying out certain dissecting procedures, we clearly identify, in a fluorescent way, the cystic choledochus junction, which makes clipping more precise.

In the third case, the patient is 28 years old and suffers from symptomatic vesicular lithiasis. In this case, we emphasize the identification of a kinking of the cyst that can be observed in a fluorescent way before culminating in/ flowing into the choledochus duct.
Likewise, we could observe the beginning of the common bile duct.
After the cystichotomy, the cannulation of the cyst, we performed the fluorescent cholangiography and fluoroscopic cholangiography in real time. Another advantage of this method is the possibility to work under direct vision because of the constant mapping of the common bile duct.
In the last case, the patient is a 51 years old man who presents an acute cholecysthitis with an evolution of 10 days.

In this video, we see the acute cholecysthitis with vesicular distention and, as we can see, it is impossible to tract it.
It can be observed that the hilum is inflamated and congestive. The use of fluorescence also provides great certainty in acute cholecysthitis by exposing the Calot´s triangle and its structures completely.
As in the previous cases, the intervention was performed alternating the xenon and the infrared light.
As the procedure advances, it is easier to clarify the cystic artery in the anterior and right region and the cystic duct that is identified in a fluorescent way in the posterior.
As we could see in the four videos the fluorescent cholangiography was a useful and accurate method to compliment the radioscopic cholangiography. Choledochian lithiais was not found in any other case. All the patients evolved favorably after the surgery.


Session Number: VidTV2 – Video Channel Rotation Day 2
Program Number: V117

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