Nikolaos Antoniou, Orestis Ioannidis, Ioannis Mantzoros, Stathis Kotidis, Loukiani Kitsikosta, Dimitris Konstantaras, Konstantinos Tsalis. Aristotle University
Laparoscopic cholecystectomy is one of the most commonly performed operations worldwide. Bile duct injury (BDI) is a rare but very serious complication of of the procedure, with a significant impact on quality of life and overall survival. The high frequency of BDI with laparoscopic cholecystectomy was first considered to be a consequence of the initial learning curve of the surgeon, but it later became clear that the primary cause of BDI is misinterpretation of biliary anatomy. Intraoperative cholangiography (IOC) has been advised by many authors as the technique reduces the risk of BDI. However, the procedure has inherent limitations and is therefore reserved for select cases.Fluorescent cholangiography using indocyanine green(ICG) is a novel approach, which offers real-time intraoperative imaging of the biliary anatomy. A comparative study was contacted by administering ICG intravenously or intrabiliary during the operation.
Forty patients scheduled to undergo an elective lap. cholecystectomy were randomly divided in two groups:
- In Group A ICG was administered in a dose 2.5mg in 2mL solution intravenously 1 hour before surgery.
- In Group B ICG was injected intrabiliary in a 0.025mg/mL solution mixed with the patient’s bile.
Results:
- Group A. Intravenous ICG was administered in 20 patients. There was no any reaction and the extrahepatic biliary anatomy was identified well. There was no BDI or any complication related to the procedure.
- Group B. ICG was injected intrabiliary in 20 patients during the laparoscopic procedure. In all but one patient the extrahepatic biliary tree was delineated very well. In one patient part of ICG solution was injected into the gallbladder wall and this resulted in a partially confusing image. There was no BDI and no postoperative complication
Conclusions: Fluorescence cholangiography can be used during laparoscopic cholecystectomy to obtain fluorescence images of the bile ducts following intrabiliary injection during the operation or intravenous injection 1 hour before the procedure. The later technique is more easy to perform and does not require catheterization of the biliary tree.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95112
Program Number: P253
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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