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Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy

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Abstract

Background

Intraoperative cholangiography (IOC) is the current gold standard for biliary imaging during laparoscopic cholecystectomy (LC). However, utilization of IOC remains low. Near-infrared fluorescence cholangiography (NIRF-C) is a novel, noninvasive method for real-time, intraoperative biliary mapping. Our aims were to assess the safety and efficacy of NIRF-C for identification of biliary anatomy during LC.

Methods

Patients were administered indocyanine green (ICG) prior to surgery. NIRF-C was used to identify extrahepatic biliary structures before and after partial and complete dissection of Calot’s triangle. Routine IOC was performed in each case. Identification of biliary structures using NIRF-C and IOC, and time required to complete each procedure were collected.

Results

Eighty-two patients underwent elective LC with NIRF-C and IOC. Mean age and body mass index (BMI) were 42.6 ± 13.7 years and 31.5 ± 8.2 kg/m2, respectively. ICG was administered 73.8 ± 26.4 min prior to incision. NIRF-C was significantly faster than IOC (1.9 ± 1.7 vs. 11.8 ± 5.3 min, p < 0.001). IOC was unobtainable in 20 (24.4 %) patients while NIRF-C did not visualize biliary structures in 4 (4.9 %) patients. After complete dissection, the rates of visualization of the cystic duct, common bile duct, and common hepatic duct using NIRF-C were 95.1, 76.8, and 69.5 %, respectively, compared to 72.0, 75.6, and 74.3 % for IOC. In 20 patients where IOC could not be obtained, NIRF-C successfully identified biliary structures in 80 % of the cases. Higher BMI was not a deterrent to visualization of anatomy with NIRF-C. No adverse events were observed with NIRF-C.

Conclusions

NIRF-C is a safe and effective alternative to IOC for imaging extrahepatic biliary structures during LC. This technique should be evaluated further under a variety of acute and chronic gallbladder inflammatory conditions to determine its usefulness in biliary ductal identification.

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Acknowledgments

Special thanks to Rebecca Dettorre, MA, CCRC, and Andrew Suzo, BS, clinical research coordinators, for assisting with patient consent and data collection. We would like to thank the Foundation for Surgical Fellowship for support of Dr. Chaudhry. We would like to acknowledge protocol development assistance we received from the Center for Clinical and Translational Science (CCTS) at The Ohio State University, NIH Award UL1TR001070. This study was funded by a grant from SAGES and an in-kind device grant from Stryker.

Disclosures

Dr. Melvin is a consultant for Stryker. Dr. Narula obtained a grant in the form of an in-kind investigational device loan from Stryker in order to conduct this study. Abdel-Rasoul, and Drs. Osayi, Wendling, Drosdeck, Chaudhry, Perry, Noria, Mikami, Needleman, Muscarella, and Hazey have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of General and Gastrointestinal Surgery, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 558 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA

    Sylvester N. Osayi, Mark R. Wendling, Joseph M. Drosdeck, Umer I. Chaudhry, Kyle A. Perry, Sabrena F. Noria, Dean J. Mikami, Bradley J. Needleman, Peter Muscarella II, David B. Renton, W. Scott Melvin, Jeffrey W. Hazey & Vimal K. Narula

  2. Center for Biostatistics, The Ohio State University, Columbus, OH, USA

    Mahmoud Abdel-Rasoul

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  1. Sylvester N. Osayi
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  2. Mark R. Wendling
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  3. Joseph M. Drosdeck
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  4. Umer I. Chaudhry
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  9. Peter Muscarella II
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  12. W. Scott Melvin
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  14. Vimal K. Narula
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Correspondence to Vimal K. Narula.

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Osayi, S.N., Wendling, M.R., Drosdeck, J.M. et al. Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy. Surg Endosc 29, 368–375 (2015). https://doi.org/10.1007/s00464-014-3677-5

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  • DOI: https://doi.org/10.1007/s00464-014-3677-5

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