Use of an Indocyanine Green Enhanced Fluorescence Optical System (the VITOM camera) for Early Recognition of Bile Leaks

Fernando Dip, MD, David Nguyen, MD, Lisandro Montorfano, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Federico Aucejo, MD, Raul J Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida

Background

In liver resections biliary leaks are the most common cause of morbidity and mortality. The near-infrared fluorescent system has been a useful tool in multiple surgical procedures for identifying normal and aberrant anatomy. The aim of this study was to determine the feasibility of the VITOM camera, an indocyanine green enhanced fluorescence optical system, in open surgery for the early recognition of biliary leaks.

Methods

Laparotomies were performed on five adult pigs. With Xenon light illumination, the right segment of the liver was exposed and resected. The cystic duct was then cannulated with a catheter, and 1 mL of indocyanine green was administrated in a retrograde fashion. The near-infrared fluorescent system consisted of a camera head and exoscope attached to an adjustable mechanical arm bar. The camera was connected to a light source capable of fluorescent and Xenon light interchangeability by a foot switch pedal. The near-infrared fluorescent system was then activated, and the liver surface was visualized. Multiple bile leaks were observed.

Results

The surgeons were not able to visualize the bile leaks with Xenon light. With the tip of the exoscope positioned 30 cm away, bile leaks were clearly identified with near-infrared light after liver resections. Bile leaks were detected in all cases in vivo. Real-time repair of the leaks was feasible with the VITOM magnification and fluorescent system.

Conclusions

The VITOM fluorescent system proved to be a useful tool in guiding intraoperative assessment of bile leaks after liver resections. This system does not require any tissue incisions, and can be performed multiple times as needed.

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