Surgical Endoscopy

, Volume 27, Issue 6, pp 2156–2162

Real-time near-infrared (NIR) fluorescent cholangiography in single-site robotic cholecystectomy (SSRC): a single-institutional prospective study

Authors

    • Department of SurgerySS Antonio e Biagio Hospital
    • Department of General and Oncologic SurgerySS Antonio e Biagio General Hospital
  • Fabio Priora
    • Department of SurgerySS Antonio e Biagio Hospital
  • Paolo Pietro Bianchi
    • Unit of Minimally Invasive SurgeryEuropean Institute of Oncology
  • Francesco Saverio Lucido
    • Department of SurgerySS Antonio e Biagio Hospital
  • Alessio Licciardello
    • Department of SurgerySS Antonio e Biagio Hospital
  • Valeria Maglione
    • Department of SurgerySS Antonio e Biagio Hospital
  • Federica Grosso
    • Department of OncologySS Antonio e Biagio Hospital
  • Raul Quarati
    • Department of SurgerySS Antonio e Biagio Hospital
  • Ferruccio Ravazzoni
    • Department of SurgerySS Antonio e Biagio Hospital
  • Luca Matteo Lenti
    • Department of SurgerySS Antonio e Biagio Hospital
Article

DOI: 10.1007/s00464-012-2733-2

Cite this article as:
Spinoglio, G., Priora, F., Bianchi, P.P. et al. Surg Endosc (2013) 27: 2156. doi:10.1007/s00464-012-2733-2

Abstract

Background

Bile duct injury is a rare but serious complication of laparoscopic cholecystectomy and the primary cause is misinterpretation of biliary anatomy. This may occur more frequently with a single-incision approach due to difficulties in exposing and visualizing the triangle of Calot. Intraoperative cholangiography was proposed to overcome this problem, but due to multiple issues, it is not used routinely. Indocyanine green (ICG) near-infrared (NIR) fluorescent cholangiography is non invasive and provides real-time biliary images during surgery, which may improve the safety of single-incision cholecystectomy. This study aims to evaluate the efficacy and safety of this technique during single-site robotic cholecystectomy (SSRC).

Methods

Patients presenting with symptomatic biliary gallstones without suspicion of common bile duct stones underwent SSRC with ICG-NIR fluorescent cholangiography using the da Vinci Fluorescence Imaging Vision System. During patient preparation, 2.5 mg of ICG was injected intravenously. During surgery, the biliary anatomy was imaged in real time, which guided dissection of Calot’s triangle. Perioperative outcomes included biliary tree visualizations, operative time, conversion and complications rates, and length of hospital stay.

Results

There were 45 cases between July 2011 and January 2012. All procedures were completed successfully; there were no conversions and at least one structure was visualized in each patient. The rates of visualization were 93 % for the cystic duct, 88 % for the common hepatic duct, and 91 % for the common bile duct prior to Calot’s dissection; after Calot’s dissection, the rates were 97 % for all three ducts. Mean hospital stay was 1.1 days and there were no bile duct injuries or any other major complications.

Conclusion

Real-time high-resolution fluorescent imaging to identify the biliary tree anatomy during SSRC using the da Vinci Fluorescence Imaging Vision System was safe and effective.

Keywords

Fluorescent cholangiographyNear-infrared fluorescenceIndocyanine greenSingle-site robotic cholecystectomySingle-incision laparoscopic surgery

Copyright information

© Springer Science+Business Media New York 2012