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Combined vascular and biliary fluorescence imaging in laparoscopic cholecystectomy

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Abstract

Background

Bile duct injury in patients undergoing laparoscopic cholecystectomy is a rare but serious complication. Concomitant vascular injury worsens the outcome of bile duct injury repair. Near-infrared fluorescence imaging using indocyanine green (ICG) is a promising, innovative, and noninvasive method for the intraoperative identification of biliary and vascular anatomy during cholecystectomy. This study assessed the practical application of combined vascular and biliary fluorescence imaging in laparoscopic gallbladder surgery for early biliary tract delineation and arterial anatomy confirmation.

Methods

Patients undergoing elective laparoscopic cholecystectomy were enrolled in this prospective, single-institutional study. To delineate the major bile ducts and arteries, a dedicated laparoscope, offering both conventional and fluorescence imaging, was used. ICG (2.5 mg) was administered intravenously immediately after induction of anesthesia and in half of the patients repeated at establishment of critical view of safety for concomitant arterial imaging. During dissection of the base of the gallbladder and the cystic duct, the extrahepatic bile ducts were visualized. Intraoperative recognition of the biliary structures was registered at set time points, as well as visualization of the cystic artery after repeat ICG administration.

Results

Thirty patients were included. ICG was visible in the liver and bile ducts within 20 minutes after injection and remained up to approximately 2 h, using the ICG-filter of the laparoscope. In most cases, the common bile duct (83 %) and cystic duct (97 %) could be identified significantly earlier than with conventional camera mode. In 13 of 15 patients (87 %), confirmation of the cystic artery was obtained successfully after repeat ICG injection. No per- or postoperative complications occurred as a consequence of ICG use.

Conclusion

Biliary and vascular fluorescence imaging in laparoscopic cholecystectomy is easily applicable in clinical practice, can be helpful for earlier visualization of the biliary tree, and is useful for the confirmation of the arterial anatomy.

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Abbreviations

ICG:

Indocyanine green

CVS:

Critical view of safety

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Acknowledgments

The authors thank Karl Storz GmbH & Co. KG (Tuttlingen, Germany) for providing the laparoscopic fluorescence imaging system and for technical assistance during the study. Furthermore, they acknowledge the surgeons and resident surgeons who performed the laparoscopic cholecystectomies in this study, and the patients who gave consent to participate in the study.

Disclosures

R.M. Schols, N.D. Bouvy, R.M. van Dam, A.A.M. Masclee, C.H.C. Dejong, and L.P.S. Stassen have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Rutger M. Schols, Nicole D. Bouvy, Ronald M. van Dam, Cornelis H. C. Dejong & Laurents P. S. Stassen

  2. Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands

    Ad A. M. Masclee

  3. NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands

    Rutger M. Schols, Nicole D. Bouvy, Ronald M. van Dam, Ad A. M. Masclee, Cornelis H. C. Dejong & Laurents P. S. Stassen

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  1. Rutger M. Schols
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  2. Nicole D. Bouvy
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  3. Ronald M. van Dam
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  4. Ad A. M. Masclee
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  5. Cornelis H. C. Dejong
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  6. Laurents P. S. Stassen
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Correspondence to Rutger M. Schols.

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Schols, R.M., Bouvy, N.D., van Dam, R.M. et al. Combined vascular and biliary fluorescence imaging in laparoscopic cholecystectomy. Surg Endosc 27, 4511–4517 (2013). https://doi.org/10.1007/s00464-013-3100-7

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  • DOI: https://doi.org/10.1007/s00464-013-3100-7

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