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

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Intraoperative incisionless fluorescent cholangiogram (IOIFC) has been demonstrated to be a useful tool to increase the visualization of Calot's triangle. This study evaluates the identification of extrahepatic biliary structures with IOIFC by medical students and surgery residents. Two pictures were taken, one with xenon light and one with near-infrared (NIR) light, at the same stage during dissection of Calot's triangle in ten different cases of laparoscopic cholecystectomy (LC). All twenty pictures were organized in a random fashion to remove any imagery bias. Twenty students and twenty residents were asked to identify the biliary anatomy. Medical students were able to accurately identify the cystic duct on an average 33.8% under the xenon light versus 86% under NIR light (p=0.0001), the common hepatic duct (CHD) on an average 19% under the xenon light versus 88.5% under NIR light (p=0.0001), and the junction on an average 24% under xenon light versus 80.5% under NIR light (p=0.0001). Surgery residents were able to accurately identify the cystic duct on an average 40% under the xenon light versus 99% under NIR light (p=0.0001), the CHD on an average 35% under the xenon light versus 96% under NIR light (p=0.0001), and the junction on an average 24% under the xenon light versus 95.5% under NIR light (p=0.0001). 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.