Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy

作者：Osayi Sylvester N; Wendling Mark R; Drosdeck Joseph M; Chaudhry Umer I; Perry Kyle A; Noria Sabrena F; Mikami Dean J; Needleman Bradley J; Muscarella Peter H; Abdel Rasoul Mahmoud; Renton David B; Melvin W Scott; Hazey Jeffrey W; Narula Vimal K^*

来源：Surgical Endoscopy and Other Interventional Techniques, 2015, 29(2): 368-375.

DOI：10.1007/s00464-014-3677-5

• Near-infrared imaging
• Fluorescence cholangiography
• Biliary mapping
• Laparoscopic cholecystectomy
• Intraoperative cholangiogram
• Indocyanine green

Background Intraoperative cholangiography (IOC) is the current gold standard for biliary imaging during laparoscopic cholecystectomy (LC). However, utilization of IOC remains low. Near- infrared fluorescence cholangiography (NIRF-C) is a novel, noninvasive method for real-time, intraoperative biliary mapping. Our aims were to assess the safety and efficacy of NIRF-C for identification of biliary anatomy during LC.
Methods Patients were administered indocyanine green (ICG) prior to surgery. NIRF-C was used to identify extrahepatic biliary structures before and after partial and complete dissection of Calot's triangle. Routine IOC was performed in each case. Identification of biliary structures using NIRF-C and IOC, and time required to complete each procedure were collected.
Results Eighty-two patients underwent elective LC with NIRF-C and IOC. Mean age and body mass index (BMI) were 42.6 +/- 13.7 years and 31.5 +/- 8.2 kg/m 2, respectively. ICG was administered 73.8 +/- 26.4 min prior to incision. NIRF-C was significantly faster than IOC (1.9 +/- 1.7 vs. 11.8 +/- 5.3 min, p < 0.001). IOC was unobtainable in 20 (24.4 %) patients while NIRF-C did not visualize biliary structures in 4 (4.9 %) patients. After complete dissection, the rates of visualization of the cystic duct, common bile duct, and common hepatic duct using NIRF-C were 95.1, 76.8, and 69.5 %, respectively, compared to 72.0, 75.6, and 74.3 % for IOC. In 20 patients where IOC could not be obtained, NIRF-C successfully identified biliary structures in 80 % of the cases. Higher BMI was not a deterrent to visualization of anatomy with NIRF-C. No adverse events were observed with NIRF-C.
Conclusions NIRF-C is a safe and effective alternative to IOC for imaging extrahepatic biliary structures during LC. This technique should be evaluated further under a variety of acute and chronic gallbladder inflammatory conditions to determine its usefulness in biliary ductal identification.

• 出版日期2015-2