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Fluorescent incisionless cholangiography as a teaching tool for identification of Calot’s triangle

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Abstract

Background

Intraoperative incisionless fluorescent cholangiogram (IOIFC) has been demonstrated to be a useful tool to increase the visualization of Calot’s triangle. This study evaluates the identification of extrahepatic biliary structures with IOIFC by medical students and surgery residents.

Methods

Two pictures were taken, one with xenon light and one with near-infrared (NIR) light, at the same stage during dissection of Calot’s triangle in ten different cases of laparoscopic cholecystectomy (LC). All twenty pictures were organized in a random fashion to remove any imagery bias. Twenty students and twenty residents were asked to identify the biliary anatomy.

Results

Medical students were able to accurately identify the cystic duct on an average 33.8 % under the xenon light versus 86 % under NIR light (p = 0.0001), the common hepatic duct (CHD) on an average 19 % under the xenon light versus 88.5 % under NIR light (p = 0.0001), and the junction on an average 24 % under xenon light versus 80.5 % under NIR light (p = 0.0001). Surgery residents were able to accurately identify the cystic duct on an average 40 % under the xenon light versus 99 % under NIR light (p = 0.0001), the CHD on an average 35 % under the xenon light versus 96 % under NIR light (p = 0.0001), and the junction on an average 24 % under the xenon light versus 95.5 % under NIR light (p = 0.0001).

Conclusions

IOIFC increases the visualization of Calot’s triangle structures when compared to xenon light. IOIFC may be a useful teaching tool in residency programs to teach LC.

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Abbreviations

IOIFC:

Intraoperative incisionless fluorescent cholangiogram

NIR:

Near infrared

LC:

Laparoscopic cholecystectomy

ICG:

Indocyanine green

IOC:

Intraoperative cholangiogram

CBD:

Common bile duct

CHD:

Common hepatic duct

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Authors and Affiliations

  1. Section of Minimally Invasive Surgery, Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA

    Mayank Roy, Fernando Dip, David Nguyen, Conrad H. Simpfendorfer, Emanuele Lo Menzo, Samuel Szomstein & Raul J. Rosenthal

Authors
  1. Mayank Roy
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  2. Fernando Dip
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  3. David Nguyen
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  4. Conrad H. Simpfendorfer
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  5. Emanuele Lo Menzo
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  6. Samuel Szomstein
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  7. Raul J. Rosenthal
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Corresponding author

Correspondence to Raul J. Rosenthal.

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Disclosures

Mayank Roy, Fernando Dip, David Nguyen, Conrad H Simpfendorfer, Emanuele Lo Menzo, Samuel Szomstein and Raul J. Rosenthal have no conflict of interest.

Additional information

Poster presentation at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Boston, MA, USA March 16-19, 2016.

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Roy, M., Dip, F., Nguyen, D. et al. Fluorescent incisionless cholangiography as a teaching tool for identification of Calot’s triangle. Surg Endosc 31, 2483–2490 (2017). https://doi.org/10.1007/s00464-016-5250-x

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  • DOI: https://doi.org/10.1007/s00464-016-5250-x

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