Fernando Dip, MD, Mayank Roy, MD, Emanuele Lo Menzo, MD, Conrad Simpfendorfer, MD, Samuel Szomstein, MD, Raul Rosenthal, MD. Cleveland Clinic Florida.
Background: Intra-operative fluorescent cholangiography (FC) has been described as a novel tool to identify the extrahepatic biliary anatomy during laparosocpic cholecystectomy (LC). We investigated the reasons why FC should be used routinely in LC.
Methods: We analyzed feasibility, cost, time, usefulness, teaching tool, safety, learning curve, x-ray exposure, complexity, and real time surgery of FC in 45 patients who underwent LC.
A single dose of 0.05 mg/kg of Indocyanin Green (ICG) (Akorn, Florida, USA) was administered intravenously one hour prior to the surgery. During the procedure, a xenon/infrared light source with charge-coupled device camera was used.
Results: FC could be performed satisfactorily in all 45 patients (100% of the cases). Individual mean cost was 14.1 ± 4.43 US dollars per patient (0.16 US dollars ICG/kg). The mean operative time was 64.95 min ± 17.43. FC took a mean time of 0.71 ± 0.26 min. The cystic duct was identified with FC in 44 out of 45 patients (97.7 %). The common hepatic duct was seen clearly in 27 of 45 patients (60%), and the common bile duct in 36 of 45(80%) patients. No allergic reactions were reported related to the use of ICG. No learning curve was necessary to use FC. X-ray was used only while performing IOC. The dissection could be performed during infrared mode of FC. Surgeons reported FC to be an effective teaching tool in 100% of the cases.
Conclusion: Fluorescent cholangiography seems to be feasible, inexpensive, expeditious, useful, and an effective teaching tool. It is safe, no learning curve is necessary, does not require x-ray, and it is easy to perform. It can be used for real time surgery to delineate the extrahepatic biliary structures. FC seems to be a tool which can be used routinely in LC.