Abstract
Background
Gallbladder cancer remains a rare cancer with a poor prognosis. National guidelines recommend radical resection in the absence of metastatic disease. This often requires extensive dissection around the extrahepatic bile ducts. We report our experience of real-time near-infrared fluorescence imaging using indocyanine green during robotic radical resection of gallbladder adenocarcinomas.
Methods
Ten patients with gallbladder adenocarcinoma underwent robotic radical resection entailing central hepatectomy (segments IV-B and V) with regional lymphadenectomy. Real-time NIRF imaging was performed using the da Vinci® Firefly system after intravenous administration of ICG 30 to 60 min preoperatively. Primary objective was to determine safety of this technique.
Results
Procedure was successfully completed in all patients. Seven patients (70%) had incidentally discovered gallbladder cancer after laparoscopic cholecystectomy and five patients had preoperatively known positive margins. Mean operative time was 173 min. Mean intraoperative blood loss was 88 mL (30–200 mL). Median number of lymph nodes retrieved was 5 (2–8). High ligation of cystic duct was performed close to the common bile duct (CBD) junction with the assist of NIRF and negative margins were achieved in all patients. No major complications (Grade III–IV) or mortality was seen at 30 days post-op.
Conclusions
Results from our limited experience demonstrate procedural safety and beneficial use of NIRF using ICG during robotic radical resection of gallbladder adenocarcinomas. It may assist in attainment of negative cystic duct margin and lymphatic clearance around the biliary tree especially in complex re-explorative biliary surgery.
Similar content being viewed by others
References
Goetze TO (2015) Gallbladder carcinoma: prognostic factors and therapeutic options. World J Gastroenterol 21(43):12211
Varshney S, Buttirini G, Gupta R (2002) Incidental carcinoma of the gallbladder. Eur J Surg Oncol (EJSO) 28(1):4–10
Xu XQ, Liu W, Li BL, Hong T, Zheng CJ, Wang C, Zhao YP (2013) Unsuspected gallbladder cancer during or after laparoscopic cholecystectomy. Chin Med Sci J 28(2):102–106
National Comprehensive Cancer Network. (2019). Hepatobiliary Cancers (version 2.2019). https://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf. Accessed 4 Mar 2019
Khan S, Beard RE, Kingham PT, Fong Y, Boerner T, Martinie JB, Vrochides D, Buell JF, Berber E, Kahramangil B, Troisi RI (2018) Long-term oncologic outcomes following robotic liver resections for primary hepatobiliary malignancies: a multicenter study. Ann Surg Oncol 25(9):2652–2660
Kabbach G, Assi HA, Bolotin G, Schuster M, Lee HJ, Tadros M (2015) Hepatobiliary tumors: update on diagnosis and management. J Clin Translational Hepatol 3(3):169
Creasy JM, Goldman DA, Dudeja V, Lowery MA, Cercek A, Balachandran VP, Allen PJ, DeMatteo RP, Kingham TP, D’Angelica MI, Jarnagin WR (2017) Systemic chemotherapy combined with resection for locally advanced gallbladder carcinoma: surgical and survival outcomes. J Am Coll Surg 224(5):906–916
Nota CL, Rinkes IH, Molenaar IQ, van Santvoort HC, Fong Y, Hagendoorn J (2016) Robot-assisted laparoscopic liver resection: a systematic review and pooled analysis of minor and major hepatectomies. HPB 18(2):113–120
Fruscione M, Pickens R, Baker EH, Cochran A, Khan A, Ocuin L, Iannitti DA, Vrochides D, Martinie JB (2019) Robotic-assisted versus laparoscopic major liver resection: analysis of outcomes from a single center. HPB 21:906
Kingham TP, Leung U, Kuk D, Gönen M, D’Angelica MI, Allen PJ, DeMatteo RP, Laudone VP, Jarnagin WR, Fong Y (2016) Robotic liver resection: a case-matched comparison. World J Surg 40(6):1422–1428
Qiu J, Chen S, Chengyou D (2016) A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc 30(3):862–875
Choi GH, Choi SH, Kim SH, Hwang HK, Kang CM, Choi JS, Lee WJ (2012) Robotic liver resection: technique and results of 30 consecutive procedures. Surg Endosc 26(8):2247–2258
Tagaya N, Shimoda M, Kato M, Nakagawa A, Abe A, Iwasaki Y, Oishi H, Shirotani N, Kubota K (2010) Intraoperative exploration of biliary anatomy using fluorescence imaging of indocyanine green in experimental and clinical cholecystectomies. J Hepato-Biliary-Pancreat Sci 17(5):595–600
Van den Bos J, Wieringa FP, Bouvy ND, Stassen LP (2018) Optimizing the image of fluorescence cholangiography using ICG: a systematic review and ex vivo experiments. Surg Endosc 32(12):4820–4832
Osayi SN, Wendling MR, Drosdeck JM, Chaudhry UI, Perry KA, Noria SF, Mikami DJ, Needleman BJ, Muscarella P, Abdel-Rasoul M, Renton DB (2015) Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy. Surg Endosc 29(2):368–375
Pesce A, Latteri S, Barchitta M, Portale TR, Di Stefano B, Agodi A, Russello D, Puleo S, La Greca G (2018) Near-infrared fluorescent cholangiography–real-time visualization of the biliary tree during elective laparoscopic cholecystectomy. HPB 20(6):538–545
Cho JY, Han HS, Yoon YS, Ahn KS, Kim YH, Lee KH (2010) Laparoscopic approach for suspected early-stage gallbladder carcinoma. Arch Surg 145(2):128–133
Jayaraman S, Jarnagin WR (2010) Management of gallbladder cancer. Gastroenterol Clin 39(2):331–342
Tran TB, Nissen NN (2015) Surgery for gallbladder cancer in the US: a need for greater lymph node clearance. J Gastrointest Oncol 6(5):452
Aloia TA, Járufe N, Javle M, Maithel SK, Roa JC, Adsay V, Coimbra FJ, Jarnagin WR (2015) Gallbladder cancer: expert consensus statement. HPB 17(8):681–690
Liu GJ, Li XH, Chen YX, Sun HD, Zhao GM, Hu SY (2013) Radical lymph node dissection and assessment: impact on gallbladder cancer prognosis. World J Gastroenterol 19(31):5150
Shirai Y, Wakai T, Sakata J, Hatakeyama K (2012) Regional lymphadenectomy for gallbladder cancer: rational extent, technical details, and patient outcomes. World J Gastroenterol 18(22):2775
Giulianotti PC, Bianco FM, Daskalaki D, Gonzalez-Ciccarelli LF, Kim J, Benedetti E (2016) Robotic liver surgery: technical aspects and review of the literature. Hepatobiliary Surg Nutr 5(4):311
Lim C, Salloum C, Tudisco A, Ricci C, Osseis M, Napoli N, Lahat E, Boggi U, Azoulay D (2019) Short-and long-term outcomes after robotic and laparoscopic liver resection for malignancies: a propensity score-matched study. World J Surg 31:1
Nota CL, Woo Y, Raoof M, Boerner T, Molenaar IQ, Choi GH, Kingham TP, Latorre K, Rinkes IH, Hagendoorn J, Fong Y (2019) Robotic versus open minor liver resections of the posterosuperior segments: a multinational, propensity score-matched study. Ann Surg Oncol 26(2):583–590
Pekolj J, Alvarez FA, Palavecino M, Clariá RS, Mazza O, de Santibañes E (2013) Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center. J Am Coll Surg 216(5):894–901
Waage A, Nilsson M (2006) Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish inpatient registry. Arch Surg 141(12):1207–1213
Funding
No funding was received for this research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
Ali Ahmad has received honoraria from Intuitive Surgical.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ahmad, A. Use of indocyanine green (ICG) augmented near-infrared fluorescence imaging in robotic radical resection of gallbladder adenocarcinomas. Surg Endosc 34, 2490–2494 (2020). https://doi.org/10.1007/s00464-019-07053-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-019-07053-w