Abstract
Introduction. Rapid developments in medical technology have allowed the incorporation of Indocyanine green (ICG) fluorescent cholangyography in the surgical technique armamentarium. The visualization of the biliary anatomy with augmented reality devices during surgery reduces complications and offer the perspective of challenging the safety paradigms which prohibited surgery in certain acute biliary conditions. Materials and methods. 43 consecutive patients were enrolled in a prospective interventional study and randomly divided into a cohort of 19 patients who had ICG injected prior to laparoscopic cholecystectomy and a cohort of 23 patients who received no fluorescent dye prior to surgery. In the ICG lot a Near Infrared Fluorescent System was used for the acquisition of fluorescent data in order to produce real time augmented reality imaging (ICG fluorescent cholangiography). The surgical technique and the indications for surgery were the same for the same in both cohorts of patients. Results and discussion. The cohort of patients receiving ICG had no complications and the mean operating time was 10 minutes less. The biliary anatomy was identified immediately in the ICG cohort with a specificity of 89.4% for the common bule duct and 73.6% for the cystic duct. In the non ICG cohort 21% of the CBDs and 43.4% of the cystic ducts were identified with difficulty during the procedure. Conclusion. We demonstrated in a small cohort of patients that early laparoscopic cholecystectomy is safe and can be performed quicker with the aid of fluorescent dyes. In order to challenge the safety paradigms around the early laparoscopic cholecystectomy a larger study is necessary.
Highlights
Rapid developments in medical technology have allowed the incorporation of Indocyanine green (ICG) fluorescent cholangyography in the surgical technique armamentarium
By intravenous administration of small amounts of fluorophores and by overlapping standard images with Near Infrared (NIR) acquired data one can obtain real time information about the very substance of the tissues such as: precise location of tubular structures which would normally be inaccessible to the naked eye common bile duct (CBD), delineation of surgical resection margins, assessment of invasion, accurate location of metastatic deposits and quality of tissue perfusion [5,6]
The introduction of laparoscopic cholecystectomy by the German surgeon Erich Mühe of Böblingen generated an increase in the bile duct injuries compared to the open approach [1]
Summary
Rapid developments in medical technology have allowed the incorporation of Indocyanine green (ICG) fluorescent cholangyography in the surgical technique armamentarium. Technologies in the medical field have known an unprecedented development over the past two decades with various devices and methods being translated into clinical practice from different engineering areas. Among these is the recent introduction of commercially available Near Infrared (NIR) Fluorescence Imaging Systems for visualization of obscure anatomical structures and assessment of tissue function and viability. Cuschieri predicted an increased risk of bile duct injuries immediately following the introduction of the laparoscopic technique but the rate of complications remained steady over two decades despite the growing number of properly trained surgeons [2].
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