Application of fluorescent cholangiography to single-incision laparoscopic cholecystectomy
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Although the use of single-incision laparoscopic cholecystectomy (SILC) is spreading rapidly, this technique has disadvantages. It does not allow for sufficient surgical views to be obtained or for intraoperative radiographic cholangiography to be performed. Fluorescent cholangiography using a preoperative intravenous injection of indocyanine green (ICG) may be useful for identifying the biliary tract during both SILC and conventional laparoscopic cholecystectomy.
For seven patients undergoing SILC, 1 ml of ICG (2.5 mg) was administered by intravenous injection before the surgery. The prototype fluorescent imaging system consisted of a xenon light source and a 30° laparoscope (diameter, 10 mm) equipped with a charge-coupled device camera capable of filtering out light with wavelengths shorter than 810 nm. The laparoscope was introduced through an umbilical trocar. Fluorescent cholangiography then was performed by changing the color images to fluorescent images using a foot switch during dissection of the triangle of Calot.
Fluorescent cholangiography identified the confluence between the cystic duct and the common hepatic duct in all seven patients before and throughout the dissection of the triangle of Calot. The interval from the injection of ICG to the first obtained fluorescent cholangiography before dissection of the triangle of Calot ranged from 35 to 75 min.
Fluorescent cholangiography enabled real-time identification of the extrahepatic bile ducts during SILC without necessitating catheterization of the bile duct. Such properties of fluorescent cholangiography are expected to be helpful for ensuring the safety of SILC and expanding the indications for the procedure.
KeywordsFluorescent cholangiography Indocyanine green Laparoscopic cholecystectomy Single-incision laparoscopic cholecystectomy
This work was supported by grants from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (no. 21791271, Kaneko), the Japanese Society for Advancement of Surgical Techniques (Ishizawa), the Japanese Foundation for Research and Promotion of Endoscopy (Ishizawa), the Takeda Science Foundation (Ishizawa), the 106th Annual Congress of JSS Memorial Surgical Research Fund (Ishizawa), the Kanae Foundation for the Promotion of Medical Science (Ishizawa), and Canon Foundation in Europe (Ishizawa).
Takeaki Ishizawa, Junichi Kaneko, Yosuke Inoue, Nobuyuki Takemura, Yasuji Seyama, Taku Aoki, Yoshifumi Beck, Yasuhiko Sugawara, Kiyoshi Hasegawa, Nobuhiro Harada, Masayoshi Ijichi, Koji Kusaka, Masayuki Shibasaki, Yasutsugu Bandai, and Norihiro Kokudo have no conflicts of interests or financial ties to disclose.
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