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Intraoperative Indocyanine Green During Cholecystectomy

  • Fernando Dip
  • Mayank Roy
  • Matthew Roche
  • Armando Rosales
  • Emanuele Lo Menzo
  • Raul J. RosenthalEmail author
Chapter

Abstract

The introduction of laparoscopic techniques has revolutionized the approach to cholecystectomy. Among the clear advantages of this approach are the quicker recovery time and overall decreased morbidity. However, concerns still remain on the higher likelihood of extrahepatic bile duct injuries. Among the different reasons to explain the reason for bile duct injury during laparoscopic cholecystectomy, misinterpretation of the visualized structures remains the most common. Several techniques to improve intraoperative identification of the biliary anatomy have been described. Intraoperative cholangiography is currently the most commonly utilized technique. However, this technique has only been shown to aid in the earlier identification of an injury and not in the prevention of it. Endoscopic ultrasound is the other common technique utilized, but this technique requires a significant learning curve and could be misinterpreted. Near-infrared fluorescent cholangiography (NIRFC) has been described as an effective technique to improve visualization of the extrahepatic biliary anatomy. This technique seems to be effective, easy to learn, cheap, and reproducible. In this chapter we describe the details of this technique and the necessary intraoperative steps to take best advantage of it, based on the current available literature and personal experience.

Keywords

Fluorescent-guided surgery Bile duct injury Laparoscopic cholecystectomy Indocyanine green 

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Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020

Authors and Affiliations

  • Fernando Dip
    • 1
  • Mayank Roy
    • 1
  • Matthew Roche
    • 1
  • Armando Rosales
    • 1
  • Emanuele Lo Menzo
    • 1
  • Raul J. Rosenthal
    • 1
    Email author
  1. 1.Department of SurgeryCleveland Clinic FloridaWestonUSA

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