Fluorescent cholangiography in a mouse model: an innovative method for improved laparoscopic identification of the biliary anatomy

Abstract

Fluorescent cholangiography based solely on the autofluorescence of bile may facilitate real-time identification of the biliary anatomy during laparoscopic procedures, without the need for extraneous dye administration or the use of radiography. This technique has the potential to decrease the rate of iatrogenic biliary tract injuries during laparoscopic cholecystectomy.

Anatomical footprint for safe laparoscopic cholecystectomy without using any energy source: a modified technique

“…Failure to identify biliary anatomy and use of energy sources [8], especially the monopolar electrosurgical hook, have been cited among the culprits [3]. The debate for and against the utility of imaging the biliary anatomy either preoperatively [9] or peroperatively [10] emphasizes the importance of proper anatomical orientation in performance of laparoscopic cholecystectomy. Respect of the anatomy of the operative area and application of experience gained from the aviation and maritime industries reduces the chances of an injury [11].…”

Laparoscopic biliary tract injury prevention: zero tolerance, error free performance

“…However, delineation of biliary anatomy may be a concern in cases with severe and extensive inflammation. Hopes were raised by beautiful delineation of the biliary anatomy in difficult circumstances by autofluorescence of bile used in an animal model [8]. Three years of scientific pursuit since then, have demonstrated its application in human beings now [9].…”

Compact instrument for fluorescence image-guided surgery

“…Thus, emission in the NIR also allows for minimal spectral overlap between the color and fluorescence channels, resulting in higher color fidelity and higher fluorescence collection efficiency. FIGS instrumentation has been developed for both open and minimally invasive surgeries.2-7 Several of these instruments feature only a single ͑fluorescence͒ channel, 2,4,6,7 or have a relatively large footprint. [2][3][4] To improve access and increase the clinical utility of FIGS, particularly for open surgical applications, 3 the size of existing imaging systems has to be reduced for greater flexibility and mobility.…”

“…[1][2][3] Applications of fluorescence image-guided surgery ͑FIGS͒ include sentinel lymph node mapping, 2,3 assessing coronary artery bypass graft patency, 4 identifying tumors intraoperatively, 5,6 and minimizing the risk of iatrogenic bile duct injury. 7 Many of these applications, such as imaging of lymphatics or vasculature, are enabled by nontargeted fluorescent contrast agents such as indocyanine green or methylene blue ͑MB͒.…”

“…FIGS instrumentation has been developed for both open and minimally invasive surgeries. [2][3][4][5][6][7] Several of these instruments feature only a single ͑fluorescence͒ channel, 2,4,6,7 or have a relatively large footprint. [2][3][4] To improve access and increase the clinical utility of FIGS, particularly for open surgical applications, 3 the size of existing imaging systems has to be reduced for greater flexibility and mobility.…”