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Use of an Image Enhancement System (IES) During Laparoscopic Cholecystectomy

Jared M McAllister, MD, Jeffrey A Blatnik, MD, Shuddhadeb Ray, MD, Sara Feaman, MA, CCRP, Margaret M Frisella, RN, L. Michael Brunt, MD. Washington University in St. Louis

Introduction: Enhanced imaging systems have been developed to alter laparoscopic camera output to facilitate visualization during laparoscopic surgery using several novel imaging modes: Clara mode reduces overexposure and reflections while brightening darker areas of the image; Chroma mode intensifies color contrast to more clearly delineate blood vessels; and a combined Chroma-Clara mode. The IES also allows the surgeon to change imaging modes throughout the procedure as needed to facilitate different portions of the operation. We hypothesized that this technology would enhance visualization of critical structures during laparoscopic cholecystectomy (LC) compared to standard laparoscopic imaging.

Methods: Videos and still images from an IES (Karl Storz Endoscopy) were assessed in 12 patients undergoing LC using the four imaging modalities. Three time points were assessed: 1) after adhesions were taken down but before any other dissection; 2) after partial dissection of the hepatocystic triangle; and 3) after establishment of the critical view of safety (CVS). Seven surgeons blinded to the imaging modalities ranked each modality from 1 (best) to 4 (worst) for each of 36 time points (3 dissection points for 12 cases).  Structures identified on achievement of the CVS were also analyzed. All statistics were performed using SPSS. Rank data was analyzed with the Friedman and Wilcoxon Signed Rank tests.

Results:  The median ranks of the Chroma and Chroma-Clara imaging modalities (median [IQR] 2[1-3] vs 2(1-2), p=0.07) were not significantly different from each other, but both ranked significantly higher than the Clara and standard modalities (median rank [IQR] 4[3-4] and 3[2-3], respectively, p<0.001). Individual surgeon preferences varied; four surgeons preferred Chroma-Clara, two preferred Chroma, one preferred Clara, and none preferred the standard mode.  In addition, the cystic artery and cystic duct were visible in all cases after achieving the CVS, but the common bile duct was visible in only 13% of cases.

Conclusion:  Enhanced imaging system technology provides modalities that were significantly preferred over standard laparoscopic imaging on retrospective review of still and video images during LC. Enhanced imaging modalities should be evaluated further to assess their impact on outcomes of LC and other laparoscopic procedures.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88281

Program Number: P481

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

122

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