Real-time near-infrared (NIR) fluorescent cholangiography in single-site robotic cholecystectomy (SSRC): a single-institutional prospective study
- 1k Downloads
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).
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.
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.
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.
KeywordsFluorescent cholangiography Near-infrared fluorescence Indocyanine green Single-site robotic cholecystectomy Single-incision laparoscopic surgery
This research was supported by Intuitive Surgical in partial fulfillment of work for the U.S. Food and Drug Administration. Drs. Giuseppe Spinoglio and Fabio Priora are scientific advisors to Intuitive Surgical. Drs. Francesco Saverio Lucido, Alessio Licciardelo, Valeria Maglione, Paolo Pietro Bianchi, Federica Grosso, Raul Quarati, Ferruccio Ravazzoni, and Luca Matteo Lenti have no conflicts of interest or financial ties to disclose.
- 16.Yousefpour Azary S, Kalbasi H, Setayesh A, Mousavi M, Hashemi A, Khodadoostan M, Zali MR, Mohammad Alizadeh AH (2011) Predictive value and main determinants of abnormal features of intraoperative cholangiography during cholecystectomy. Hepatobiliary Pancreat Dis Int 10(3):308–312PubMedCrossRefGoogle Scholar
- 26.Schaafsma BE, Mieog JS, Hutteman M, van der Vorst JR, Kuppen PJ, Löwik CW, Frangioni JV, van de Velde CJ, Vahrmeijer AL (2011) The clinical use of indocyanine green as a near-infrared fluorescent contrast agent for image-guided oncologic surgery. J Surg Oncol 104(3):323–332PubMedCrossRefGoogle Scholar
- 30.Ishizawa T, Kaneko J, Inoue Y, Takemura N, Seyama Y, Aoki T, Beck Y, Sugawara Y, Hasegawa K, Harada N, Ijichi M, Kusaka K, Shibasaki M, Bandai Y, Kokudo N (2011) Application of fluorescent cholangiography to single-incision laparoscopic cholecystectomy. Surg Endosc 25(8):2631–2636PubMedCrossRefGoogle Scholar
- 31.Spinoglio G, Lenti LM, Maglione V, Lucido FS, Priora F, Bianchi PP, Grosso F, Quarati R (2012) Single-site robotic cholecystectomy (SSRC) versus single-incision laparoscopic cholecystectomy (SILC): comparison of learning curves. First European experience. Surg Endosc 26(6):1648–1655PubMedCrossRefGoogle Scholar