Fluorescent incisionless cholangiography as a teaching tool for identification of Calot’s triangle

Roy, Mayank; Dip, Fernando; Nguyen, David; Simpfendorfer, Conrad; Menzo, Emanuele Lo; Szomstein, Samuel; Rosenthal, Raúl J.

doi:10.1007/s00464-016-5250-x

Cited by 33 publications

(20 citation statements)

References 22 publications

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“…In this study, the ability of fluorescence cholangiography to visualize the critical junction between the cystic duct, common hepatic duct and common bile duct during elective laparoscopic cholecystectomy was non‐inferior to that of X‐ray cholangiography. Fluorescence cholangiography has a steep learning curve, but is non‐invasive, allows easy switching between white light mode and fluorescence mode, and does not require a patent cystic duct. It is potentially a useful teaching tool for young surgeons and might lead to a reduction in the incidence of bile duct injury.…”

Section: Discussionmentioning

confidence: 99%

“…Fluorescence cholangiography has a steep learning curve, but is non‐invasive, allows easy switching between white light mode and fluorescence mode, and does not require a patent cystic duct. It is potentially a useful teaching tool for young surgeons and might lead to a reduction in the incidence of bile duct injury. In patients with suspected common bile duct stones, X‐ray cholangiography will continue to be the standard as fluorescence cholangiography is considered inaccurate.…”

Section: Discussionmentioning

confidence: 99%

“…The two study surgeons were experienced laparoscopic upper gastrointestinal surgeons; each had undertaken more than 400 cholecystectomies, over 100 X‐ray cholangiography procedures and more than 20 fluorescence cholangiography procedures. The learning curve for fluorescence cholangiography is steep and probably less than five procedures.…”

Section: Methodsmentioning

confidence: 99%

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Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

Lehrskov

Westen²,

Larsen³

et al. 2020

British Journal of Surgery

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Background: Safe laparoscopic cholecystectomy may necessitate biliary imaging, and non-invasive fluorescence cholangiography may have advantages over contrast X-ray cholangiography. This trial compared fluorescence and X-ray cholangiography for visualization of the critical junction between the cystic, common hepatic and common bile ducts. Methods: This non-inferiority blinded RCT included patients who had either intraoperative fluorescence cholangiography using 0⋅05 mg/kg indocyanine green or X-ray cholangiography during elective laparoscopic cholecystectomy.Results: Between March 2015 and August 2018, a total of 120 patients were randomized (60 in each group). There were no drop-outs and 30-day follow-up data were available for all patients. In intention-to-treat analysis, there was no difference between the fluorescence and X-ray cholangiography groups in ability to visualize the critical junction (49 of 60 versus 51 of 60 respectively; P = 0⋅230). Fluorescence cholangiography was faster by a few minutes: median 2⋅0 (range 0⋅5-5⋅0) versus 4⋅8 (1⋅3-17⋅6) min (P < 0⋅001).Conclusion: Fluorescence cholangiography was confirmed to be non-inferior to X-ray cholangiography in visualizing the critical junction during laparoscopic cholecystectomy. Registration number: NCT02344654 (http://www.clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

Lehrskov

Westen²,

Larsen³

et al. 2020

British Journal of Surgery

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“…Finally, NIR-ICG is easy to perform and to learn. A short learning curve has been described and it has been shown to be a good learning tool for surgeons in training (35)(36)(37).…”

Section: How the Intervention Might Workmentioning

confidence: 99%

Systematic Review Protocol. Near Infra-Red Indocyanine Green Fluorescent Cholangiography Versus Intraoperative Cholangiography to Improve Safety in Laparoscopic Cholecystectomy for Gallstone Disease – A Systematic Review Protocol.

Boira

Memba

Bashir

et al. 2020

Preprint

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BackgroundLaparoscopic cholecystectomy has become the standard surgical approach in the treatment of cholelithiasis. The rate of bile duct injury increased significantly during the initial period of its implementation. Diverse surgical techniques and different imaging modalities have been described to provide enhanced views of the biliary anatomy and potentially prevent or early detect bile duct injuries. Both x-ray intraoperative cholangiography (IOC) and Near infra-red indocyanine green fluorescent cholangiography (NIR-ICG) have been described as safe and feasible techniques to assess biliary anatomy. The aim of this systematic review is to evaluate if NIR-ICG can visualise extrahepatic biliary anatomy more efficiently and safer than IOC in minimally invasive cholecystectomy for gallstone disease.MethodsLiterature search will be performed via Medline (PubMed), Embase, Scopus, the Cochrane Central Register of Controlled Trials and web of science. All randomised controlled clinical trials and prospective non-randomised controlled trials which report on comparison of NIR-ICG versus IOC will be included. All patients over 18 years old who require elective or urgent minimally invasive cholecystectomy (undergoing NIR-ICG during this procedure) due to gallstone disease both acute and chronic will be included. Primary outcomes will be ability to visualise extrahepatic biliary anatomy and time to obtain relevant images of the biliary tree.DiscussionOur research expects to give the reader a clear sense of the needed focus of future research and remaining uncertainties in the field. Understanding the benefits of this technique is critical to ensuring policymakers can make informed decisions as to where preventive efforts should be focused regarding specific imaging techniques. If ICG is proven to be faster and non-invasive, routine use could be encouraged and wide implementation could be a reality. Systematic review registrationIn accordance with the guidelines, our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42020177991.

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“…In fact, fluorescence imaging enhances the intraoperative visualization of anatomical structures that are to be respected during surgical procedures. For example, biliary excreted fluorophores can help visualize the biliary tree for a safer cholecystectomy can be used to highlight the urinary tract and reduce risks of iatrogenic injuries during pelvic surgery or bottom‐up transanal total mesorectal excision …”

Section: New Intraoperative Imaging Technologies Overviewmentioning

confidence: 99%

New intraoperative imaging technologies: Innovating the surgeon’s eye toward surgical precision

Mascagni

Longo

Barberio

et al. 2018

Journal of Surgical Oncology

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Fluorescent incisionless cholangiography as a teaching tool for identification of Calot’s triangle

Abstract: IOIFC increases the visualization of Calot's triangle structures when compared to xenon light. IOIFC may be a useful teaching tool in residency programs to teach LC.

Cited by 33 publications

References 22 publications

Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

Systematic Review Protocol. Near Infra-Red Indocyanine Green Fluorescent Cholangiography Versus Intraoperative Cholangiography to Improve Safety in Laparoscopic Cholecystectomy for Gallstone Disease – A Systematic Review Protocol.

New intraoperative imaging technologies: Innovating the surgeon’s eye toward surgical precision

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