Skip to main content
SpringerLink
Log in

Radiation exposure during laparoscopic cholecystectomy with routine intraoperative cholangiography

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

For many years, intraoperative cholangiography during cholecystectomy to aid definition of the biliary anatomy and to detect choledocholithiasis has been advocated. Although radiation exposure in fluoroscopic procedures is a concern, few available data exist regarding the radiation exposure incurred during intraoperative cholangiography. This study aimed to determine the average radiation exposure sustained during this procedure.

Methods

Radiation dose data were recorded between 5 September 2007 and 21 July 2008 for 108 consecutive patients undergoing laparoscopic cholecystectomy with intraoperative cholangiography. Dose area product values were used to calculate the entrance skin dose, an indicator of potential skin damage, and the effective dose, an indicator of long-term cancer risk, for each patient.

Results

The median age of the 108 patients (67% females) included in the data analysis was 51 years (range, 17–87 years). The mean entrance skin dose during intraoperative cholangiography was 0.0069 ± 0.0066 Gy, and the mean effective dose was 0.18 ± 0.17 mSv. No results exceeded the threshold of 2 Gy for skin damage, and the lifetime risk for the development of new cancer due to intraoperative cholangiography was less than 0.001%.

Conclusion

Radiation doses administered during intraoperative cholangiography are safe and do not represent a contraindication to this procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mirrizi P (1937) Operative cholangiography. Surg Gynecol Obstet 65:702–710

    Google Scholar 

  2. Connor S, Garden OJ (2006) Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 93:158–168

    Article  PubMed  CAS  Google Scholar 

  3. Metcalfe MS, Ong T, Bruening MH, Iswariah H, Wemyss-Holden SA, Maddern GJ (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 187:475–481

    Article  PubMed  Google Scholar 

  4. International Commission on Radiological Protection (2000) Avoidance of radiation injuries from medical interventional procedures. ICRP Publication 85. Pergamon Press, Oxford

    Google Scholar 

  5. International Commission on Radiological Protection (2008) Recommendations of the ICRP annals of the ICRP v. 37/2-4. ICRP Publication 103. Elsevier, Stockholm

    Google Scholar 

  6. International Commission on Radiological Protection (1991) 1990 recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Pergamon Press, Oxford

    Google Scholar 

  7. Miller DL, Balter S, Noonan PT, Georgia JD (2002) Minimizing radiation-induced skin injury in interventional radiology procedures. Radiology 225:329–336

    Article  PubMed  Google Scholar 

  8. Crawley MT, Rogers AT (2000) Dose-area product measurements in a range of common orthopaedic procedures and their possible use in establishing local diagnostic reference levels. Br J Radiol 73:740–744

    PubMed  CAS  Google Scholar 

  9. Weerakkody RA, Walsh SR, Cousins C, Goldstone KE, Tang TY, Gaunt ME (2008) Radiation exposure during endovascular aneurysm repair. Br J Surg 95:699–702

    Article  PubMed  CAS  Google Scholar 

  10. Heyd RL, Kopecky KK, Sherman S, Lehman GA, Stockberger SM (1996) Radiation exposure to patients and personnel during interventional ERCP at a teaching institution. Gastrointest Endosc 44:287–292

    Article  PubMed  CAS  Google Scholar 

  11. Tsalafoutas IA, Paraskeva KD, Yakoumakis EN, Vassilaki AE, Maniatis PN, Karagiannis JA, Koulentianos ED (2003) Radiation doses to patients from endoscopic retrograde cholangiopancreatography examinations and image quality considerations. Radiat Prot Dosimetry 106:241–246

    PubMed  CAS  Google Scholar 

  12. Williams JR (1997) Radiation doses to patients from endoscopic retrograde cholangiopancreatography examinations and image quality considerations. Br J Radiol 70:498–503

    PubMed  CAS  Google Scholar 

  13. Efstathopoulos EP, Karvouni E, Kottou S, Tzanalaridou E, Korovesis S, Giazitzoglou E, Katritsis DG (2004) Patient dosimetry during coronary interventions: a comprehensive analysis. Am Heart J 147:468–475

    Article  PubMed  Google Scholar 

  14. Miller DL, Balter S, Cole PE, Lu HT, Schueler BA, Geisinger M, Cardella JF, George JS, Miller GL III, Anderson J (2003) Radiation doses in interventional radiology procedures: the RAD-IR study: part I: overall measures of dose. J Vasc Interv Radiol 14:711–727

    Article  PubMed  Google Scholar 

  15. Miller DL, Balter S, Cole PE, Lu HT, Berenstein A, Albert R, Schueler BA, Georgia JD, Noonan PT, Russell EJ, Malisch TW, Vogelzang RL, Geisinger M, Cardella JF, George JS, Miller GL III, Anderson J (2003) Radiation doses in interventional radiology procedures: the RAD-IR study: part II: skin dose. J Vasc Interv Radiol 14:977–990

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 201, Level 7, Hills Road, Cambridge, CB2 0QQ, UK

    A. Karthikesalingam, Sheraz R. Markar, Ruwan Weerakkody, Stewart R. Walsh & Raaj K. Praseedom

  2. Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK

    Nicholas Carroll

Authors
  1. A. Karthikesalingam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sheraz R. Markar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ruwan Weerakkody
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stewart R. Walsh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicholas Carroll
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raaj K. Praseedom
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raaj K. Praseedom.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karthikesalingam, A., Markar, S.R., Weerakkody, R. et al. Radiation exposure during laparoscopic cholecystectomy with routine intraoperative cholangiography. Surg Endosc 23, 1845–1848 (2009). https://doi.org/10.1007/s00464-008-0279-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-0279-0

Keywords

Search

Navigation