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Use of Fluorescence Guidance in Cholecystectomy

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The SAGES Manual of Fluorescence-Guided Surgery

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Abstract

Laparoscopic cholecystectomy (LC) is the most common elective abdominal surgery in the United States. Fluorescence cholangiography (FC) using indocyanine green (ICG) dye and near-infrared (NIR) fluorescent camera/light source permits real-time identification of extrahepatic biliary structures to facilitate dissection without requiring biliary tree cannulation and has minimal risk. Literature review and analysis shows fluorescence cholangiography, used in conjunction with the SAGES safe cholecystectomy technique and “critical view of safety,” is a noninvasive adjunct to laparoscopic cholecystectomy with improved patient outcomes. These findings support FC with ICG as standard of care during laparoscopic cholecystectomy.

The learning objective of the following chapter includes a review of current literature in this area while understanding the advantages and limitations of fluorescence cholangiography in cholecystectomy.

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References

  1. Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg. 1993;165(1):9–14. https://doi.org/10.1016/S0002-9610(05)80397-6.

    Article  CAS  PubMed  Google Scholar 

  2. Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in Medicare beneficiaries. J Am Med Assoc. 2003;290(16):2168–73. https://doi.org/10.1001/jama.290.16.2168.

    Article  CAS  Google Scholar 

  3. Dolan JP, Diggs BS, Sheppard BC, Hunter JG. Ten-year trend in the national volume of bile duct injuries requiring operative repair. Surg Endosc Other Interv Tech. 2005;19(7):967–73. https://doi.org/10.1007/s00464-004-8942-6.

    Article  CAS  Google Scholar 

  4. Halbert C, Pagkratis S, Yang J, et al. Beyond the learning curve: incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era. Surg Endosc. 2016;30(6):2239–43. https://doi.org/10.1007/s00464-015-4485-2.

    Article  PubMed  Google Scholar 

  5. Savader SJ, Lillemoe KD, Prescott CA, Winick AB, Venbrux AC, Lund GB, Mitchell SE, Cameron JL, Osterman FA Jr. Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster. Ann Surg. 1997;225(3):268–73. https://doi.org/10.1097/00000658-199703000-00005. PMID: 9060582; PMCID: PMC1190676.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Ishizawa T, Tamura S, Masuda K, Aoki T, Hasegawa K, Imamura H, Beck Y, Kokudo N. Intraoperative fluorescent cholangiography using indocyanine green: a biliary road map for safe surgery. J Am Coll Surg. 2009;208(1):e1–4. https://doi.org/10.1016/j.jamcollsurg.2008.09.024. Epub 2008 Oct 31. PMID: 19228492.

    Article  PubMed  Google Scholar 

  7. Ishizawa T, Bandai Y, Ijichi M, Kaneko J, Hasegawa K, Kokudo N. Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy. Br J Surg. 2010;97:1369. https://doi.org/10.1002/bjs.7125.

    Article  CAS  PubMed  Google Scholar 

  8. Boni L, David G, Mangano A, Dionigi G, Rausei S, Spampatti S, Cassinotti E, Fingerhut A. Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc. 2015;29(7):2046–55. https://doi.org/10.1007/s00464-014-3895-x. Epub 2014 Oct 11. PMID: 25303914; PMCID: PMC4471386.9.

    Article  PubMed  Google Scholar 

  9. Oddi A, Di Nicola V, Panzini A, et al. The intraoperative visualization of the bile ducts by the use of fluorescent substances. A feasibility study. G Chir. 1996;17(11–12):620–3.

    CAS  PubMed  Google Scholar 

  10. Sandler BJ. Immunofluorescence in the operating room for biliary visualization and perfusion assessment - a SAGES Technology and Value Assessment [Internet]. SAGES. 2019 [cited 2022 May 1]. Available from: https://www.sages.org/publications/tavac/immunofluorescence-operating-room-biliary-visualization-perfusion-assessment/.

  11. Osayi SN, Wendling MR, Drosdeck JM, Chaudhry UI, Perry KA, Noria SF, Mikami DJ, Needleman BJ, Muscarella P 2nd, Abdel-Rasoul M, Renton DB, Melvin WS, Hazey JW, Narula VK. Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy. Surg Endosc. 2015;29(2):368–75. https://doi.org/10.1007/s00464-014-3677-5. Epub 2014 Jul 2. PMID: 24986018; PMCID: PMC4415528.

    Article  PubMed  Google Scholar 

  12. Dip F, Nguyen D, Montorfano L, et al. Accuracy of near infrared-guided surgery in morbidly obese subjects undergoing laparoscopic cholecystectomy. Obes Surg. 2016;26(3):525–30. https://doi.org/10.1007/s11695-015-1781-9.

    Article  PubMed  Google Scholar 

  13. Spinoglio G, P.F. Real-time near-infrared (NIR) fluorescent cholangiography in single site robotic cholecystectomy (SSRC): a single institutional study. Surg Endosc. 2013;27:2156–62.

    Article  PubMed  Google Scholar 

  14. Dip F, LoMenzo E, Sarotto L, et al. Randomized trial of near-infrared incisionless fluorescent cholangiography. Ann Surg. 2019;270(6):992–9. https://doi.org/10.1097/SLA.0000000000003178.

    Article  PubMed  Google Scholar 

  15. Lim SH, Tan HTA, Shelat VG. Comparison of indocyanine green dye fluorescent cholangiography with intra-operative cholangiography in laparoscopic cholecystectomy: a meta-analysis. Surg Endosc. 2021;35(4):1511–20. https://doi.org/10.1007/s00464-020-08164-5. Epub 2021 Jan 4. PMID: 33398590.

    Article  PubMed  Google Scholar 

  16. Broderick RC, Lee AM, Cheverie JN, et al. Fluorescent cholangiography significantly improves patient outcomes for laparoscopic cholecystectomy. Surg Endosc. 2021;35(10):5729–39. https://doi.org/10.1007/S00464-020-08045-X.

    Article  PubMed  Google Scholar 

  17. Broderick RC, Li JZ, Huang EY, Blitzer RR, Lee AM, Serra JL, Bouvet M, Sandler BJ, Jacobsen GR, Horgan S. Lighting the way with fluorescent cholangiography in laparoscopic cholecystectomy: reviewing 7 years of experience. J Am Coll Surg. 2022;235(5):713–23. https://doi.org/10.1097/XCS.0000000000000314. Epub 2022 Oct 17. PMID: 36102574.

    Article  PubMed  Google Scholar 

  18. Ambe PC, Plambeck J, Fernandez-Jesberg V, Zarras K. The role of indocyanine green fluoroscopy for intraoperative bile duct visualization during laparoscopic cholecystectomy: an observational cohort study in 70 patients. Patient Saf Surg. 2019;13:2. https://doi.org/10.1186/s13037-019-0182-8. PMID: 30651756; PMCID: PMC6330420.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bleszynski MS, DeGirolamo KM, Meneghetti AT, Chiu CJ, Panton ON. Fluorescent cholangiography in laparoscopic cholecystectomy: an updated Canadian experience. Surg Innov. 2020;27(1):38–43. https://doi.org/10.1177/1553350619885792. Epub 2019 Nov 19. PMID: 31744398.

    Article  PubMed  Google Scholar 

  20. Yoshiya S, Minagawa R, Kamo K, Kasai M, Taketani K, Yukaya T, Kimura Y, Koga T, Kai M, Kajiyama K, Yoshizumi T. Usability of intraoperative fluorescence imaging with indocyanine green during laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. World J Surg. 2019;43(1):127–33. https://doi.org/10.1007/s00268-018-4760-1. PMID: 30105635.

    Article  PubMed  Google Scholar 

  21. Esposito C, Corcione F, Settimi A, Farina A, Centonze A, Esposito G, Spagnuolo MI, Escolino M. Twenty-five year experience with laparoscopic cholecystectomy in the pediatric population-from 10 mm clips to indocyanine green fluorescence technology: long-term results and technical considerations. J Laparoendosc Adv Surg Tech A. 2019;29(9):1185–91. https://doi.org/10.1089/lap.2019.0254. Epub 2019 Jun 14. PMID: 31199700.

    Article  PubMed  Google Scholar 

  22. Reeves JJ, Broderick RC, Lee AM, et al. The price is right: routine fluorescent cholangiography during laparoscopic cholecystectomy. Surgery. 2021;171(5):1168–76. https://doi.org/10.1016/j.surg.2021.09.027.

    Article  PubMed  Google Scholar 

  23. Hiwatashi K, Okumura H, Setoyama T, et al. Evaluation of laparoscopic cholecystectomy using indocyanine green cholangiography including cholecystitis. Medicine. 2018;97(30):e11654. https://doi.org/10.1097/MD.0000000000011654.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Dip FD, Asbun D, Rosales-Velderrain A, et al. Cost analysis and effectiveness comparing the routine use of intraoperative fluorescent cholangiography with fluoroscopic cholangiogram in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2014;28(6):1838–43. https://doi.org/10.1007/s00464-013-3394-5.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, USA

    Ryan C. Broderick & Santiago Horgan

  2. Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    David Renton

Authors
  1. Ryan C. Broderick
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  2. David Renton
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  3. Santiago Horgan
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Corresponding author

Correspondence to Ryan C. Broderick .

Editor information

Editors and Affiliations

  1. Department of Surgery, West Virginia University, Morgantown, WV, USA

    Nova Szoka

  2. Division of General Surgery, Ohio State University, Columbus, OH, USA

    David Renton

  3. Department of Surgery, University of California, San Diego, San Diego, CA, USA

    Santiago Horgan

Electronic Supplementary Material

Bright light and fluorescence view of adipose-covered cystic and common bile duct (MP4 94879 kb)

Bright light and fluorescence views showing infundibulum of the gallbladder closely adherent to common bile duct better appreciated with ICG (MP4 68686 kb)

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Broderick, R.C., Renton, D., Horgan, S. (2023). Use of Fluorescence Guidance in Cholecystectomy. In: Szoka, N., Renton, D., Horgan, S. (eds) The SAGES Manual of Fluorescence-Guided Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-40685-0_4

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  • DOI: https://doi.org/10.1007/978-3-031-40685-0_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-40684-3

  • Online ISBN: 978-3-031-40685-0

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