Incisionless fluorescent cholangiography (IFC): a pilot survey of surgeons on procedural familiarity, practices, and perceptions



Incisionless fluorescent cholangiography (IFC) has recently been proven feasible, safe, and efficacious as an intraoperative procedure to help identify extrahepatic bile ducts during laparoscopic cholecystectomies (LC). We conducted a pilot survey of 51 surgeons attending an international conference who perform endoscopic cholecystectomies to identify their typical LC practices, and perceptions of IFC.


An international panel of ten IFC experts, all with > 500 prior IFC procedures and related research publications, convened during the 4th International Congress of Fluorescence-Guided Surgery in Boca Raton, Florida in February 2017. The panel was charged with developing questions about LC practices and experience with IFC, and perceptions regarding its advantages, barriers to use, and indications. These questions then were asked to other congress attendees during one of the didactic sessions using an online polling application. Attendees, who ranged from zero to considerable experience performing IFC, accessed the survey via their portable devices.


Of the 51 survey participants, 51% were from North America; 77% identified themselves as general/minimally invasive surgeons, and roughly 60% performed under 50 cholecystectomies/year. Only 12% performed routine intraoperative cholangiography (IOC), while 72.3% routinely performed critical safety reviews. Thirty-five percent estimated that their institution’s laparoscopic-to-open surgery conversion rate was > 1% during LC. Roughly 95% of respondents felt that surgeons should have access to a noninvasive method for evaluating extrahepatic biliary structures; 84% felt that the most advantageous characteristic of IFC is the lack of any biliary-tree incision; and 93.3% felt that IFC would have considerable educational value in surgical training programs; and 78% felt that any surgeon who performs LC could benefit.


Surgeons who participated in our survey overwhelmingly recommended the routine use of IFC during laparoscopic cholecystectomy as a complimentary imaging technique. Prospective randomized clinical trials remain necessary to determine whether IFC reduces the incidence of bile duct injuries and other LC complications.

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We would like to gratefully acknowledge the funding for the conference by Karl Storz.


Karl Storz provided funds for this international panel of experts to meet during the 4th International Congress of Fluorescence Guided Surgery in Boca Raton, Florida in February 2017.

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Correspondence to Raul J. Rosenthal.

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Dr. Rosenthal is on the Advisory Board: Diagnostic Green; Educational Grants: Medtronics, Karl Storz Endoscopy, Ethicon Endosurgery. Dr. Dip received an Educational Grant from Karl Storz Endoscopy, Advisory Board for Diagnostic Green Inc. Dr. Lee, who helped to orchestrate this survey, discloses that Karl Storz Endoscopy America, Inc provided funding for the session during which this survey was conducted at the 4th International Congress. Dr. White is an independent research consultant, hired and paid by RR and FD to assist with this project. He has no links to any company other than his own, Science Right Research Consulting. Doctors Sarotto, Mayank, LoMenzo, Walsh, Carus, Schneider, Boni, Ishizawa, and Kokudo have no conflicts of interest or financial ties to disclose.

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Appendix 1

Appendix 1

See Table 4.

Table 4 Questions asked during the survey

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Dip, F., Sarotto, L., Roy, M. et al. Incisionless fluorescent cholangiography (IFC): a pilot survey of surgeons on procedural familiarity, practices, and perceptions. Surg Endosc 34, 675–685 (2020).

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  • Incisionless fluorescent cholangiography
  • Laparoscopic cholecystectomy
  • Intraoperative radiologic cholangiography
  • Bile duct injury
  • Near-infrared fluorescence
  • Fluorescence-guided surgery