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Routine use of fluorescent incisionless cholangiography as a new imaging modality during laparoscopic cholecystectomy

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Abstract

Background

Intraoperative incisionless fluorescent cholangiography (IOIFC) has been described to identify extrahepatic biliary anatomy. Potential advantages of the routine use of intraoperative incisionless fluorescent cholangiography were evaluated in a consecutive series of cases.

Methods

A total of 45 patients undergoing laparoscopic cholecystectomy between January and July 2013 were consented and included in this study. We analyzed a prospectively collected database for feasibility, cost, time, usefulness, teaching tool, safety, learning curve, X-ray exposure, complexity, and real-time surgery of IOIFC. A single dose of 0.05 mg/kg of Indocyanine green was administered prior to surgery. During the procedure, a laparoscopic fluorescence system was used.

Results

IOIFC could be performed in all 45 patients, whereas intraoperative cholangiography could be performed in 42 (93 %). Individual median cost of performing IOFC was cheaper than IOC (13.97 ± 4.3 vs 778.43 ± 0.4 USD) per patient, p = 0.0001). IOFC was faster than IOC (0.71 ± 0.26 vs 7.15 ± 3.76 minutes, p < 0.0001). The cystic duct was identified by IOFC in 44 out of 45 patients (97.77 %).

Conclusion

IOIFC appears to be a feasible, low-cost, expeditious, useful, and effective imaging modality when performing LC. It is safe, easy to perform and interpret, and does not require a learning curve or X-ray. It can be used for real time surgery to delineate the extrahepatic biliary structures

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Disclosures

This study was made possible by an educational Grant from Karl Storz Endoscopy. Doctors Fernando Dip, Mayank Roy, Emanuele Lo Menzo, Conrad Simpfendorfer, Samuel Szomstein, and Raul Rosenthal have no additional disclosures.

Fundings

Funding and equipment from Karl Storz, Tuttlingen, Germany.

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Authors and Affiliations

  1. Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA

    Fernando Dip, Mayank Roy, Emanuele Lo Menzo, Conrad Simpfendorfer, Samuel Szomstein & Raul J. Rosenthal

Authors
  1. Fernando Dip
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  2. Mayank Roy
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  3. Emanuele Lo Menzo
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  4. Conrad Simpfendorfer
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  5. Samuel Szomstein
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  6. Raul J. Rosenthal
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Corresponding author

Correspondence to Raul J. Rosenthal.

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Dip, F., Roy, M., Menzo, E.L. et al. Routine use of fluorescent incisionless cholangiography as a new imaging modality during laparoscopic cholecystectomy. Surg Endosc 29, 1621–1626 (2015). https://doi.org/10.1007/s00464-014-3853-7

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  • DOI: https://doi.org/10.1007/s00464-014-3853-7

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