Real-time near-infrared (NIR) fluorescent cholangiography in single-site robotic cholecystectomy (SSRC): A single-institutional prospective study

Giuseppe Spinoglio, Fabio Priora, Paolo Pietro Bianchi, Francesco Saverio Lucido, Alessio Licciardello, Valeria Maglione, Federica Grosso, Raul Quarati, Ferruccio Ravazzoni, Luca Matteo Lenti

Research output: Contribution to journalArticle

Abstract

Background: Bile duct injury is a rare but serious complication of laparoscopic cholecystectomy and the primary cause is misinterpretation of biliary anatomy. This may occur more frequently with a single-incision approach due to difficulties in exposing and visualizing the triangle of Calot. Intraoperative cholangiography was proposed to overcome this problem, but due to multiple issues, it is not used routinely. Indocyanine green (ICG) near-infrared (NIR) fluorescent cholangiography is non invasive and provides real-time biliary images during surgery, which may improve the safety of single-incision cholecystectomy. This study aims to evaluate the efficacy and safety of this technique during single-site robotic cholecystectomy (SSRC). Methods: Patients presenting with symptomatic biliary gallstones without suspicion of common bile duct stones underwent SSRC with ICG-NIR fluorescent cholangiography using the da Vinci Fluorescence Imaging Vision System. During patient preparation, 2.5 mg of ICG was injected intravenously. During surgery, the biliary anatomy was imaged in real time, which guided dissection of Calot's triangle. Perioperative outcomes included biliary tree visualizations, operative time, conversion and complications rates, and length of hospital stay. Results: There were 45 cases between July 2011 and January 2012. All procedures were completed successfully; there were no conversions and at least one structure was visualized in each patient. The rates of visualization were 93 % for the cystic duct, 88 % for the common hepatic duct, and 91 % for the common bile duct prior to Calot's dissection; after Calot's dissection, the rates were 97 % for all three ducts. Mean hospital stay was 1.1 days and there were no bile duct injuries or any other major complications. Conclusion: Real-time high-resolution fluorescent imaging to identify the biliary tree anatomy during SSRC using the da Vinci Fluorescence Imaging Vision System was safe and effective.

Original languageEnglish
Pages (from-to)2156-2162
Number of pages7
JournalSurgical Endoscopy and Other Interventional Techniques
Volume27
Issue number6
DOIs
Publication statusPublished - Jun 2013

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Cholangiography
Robotics
Cholecystectomy
Indocyanine Green
Prospective Studies
Dissection
Length of Stay
Anatomy
Optical Imaging
Common Bile Duct
Biliary Tract
Bile Ducts
Cystic Duct
Safety
Common Hepatic Duct
Laparoscopic Cholecystectomy
Wounds and Injuries
Gallstones
Operative Time

Keywords

  • Fluorescent cholangiography
  • Indocyanine green
  • Near-infrared fluorescence
  • Single-incision laparoscopic surgery
  • Single-site robotic cholecystectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Real-time near-infrared (NIR) fluorescent cholangiography in single-site robotic cholecystectomy (SSRC) : A single-institutional prospective study. / Spinoglio, Giuseppe; Priora, Fabio; Bianchi, Paolo Pietro; Lucido, Francesco Saverio; Licciardello, Alessio; Maglione, Valeria; Grosso, Federica; Quarati, Raul; Ravazzoni, Ferruccio; Lenti, Luca Matteo.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 27, No. 6, 06.2013, p. 2156-2162.

Research output: Contribution to journalArticle

Spinoglio, G, Priora, F, Bianchi, PP, Lucido, FS, Licciardello, A, Maglione, V, Grosso, F, Quarati, R, Ravazzoni, F & Lenti, LM 2013, 'Real-time near-infrared (NIR) fluorescent cholangiography in single-site robotic cholecystectomy (SSRC): A single-institutional prospective study', Surgical Endoscopy and Other Interventional Techniques, vol. 27, no. 6, pp. 2156-2162. https://doi.org/10.1007/s00464-012-2733-2
Spinoglio, Giuseppe ; Priora, Fabio ; Bianchi, Paolo Pietro ; Lucido, Francesco Saverio ; Licciardello, Alessio ; Maglione, Valeria ; Grosso, Federica ; Quarati, Raul ; Ravazzoni, Ferruccio ; Lenti, Luca Matteo. / Real-time near-infrared (NIR) fluorescent cholangiography in single-site robotic cholecystectomy (SSRC) : A single-institutional prospective study. In: Surgical Endoscopy and Other Interventional Techniques. 2013 ; Vol. 27, No. 6. pp. 2156-2162.
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abstract = "Background: Bile duct injury is a rare but serious complication of laparoscopic cholecystectomy and the primary cause is misinterpretation of biliary anatomy. This may occur more frequently with a single-incision approach due to difficulties in exposing and visualizing the triangle of Calot. Intraoperative cholangiography was proposed to overcome this problem, but due to multiple issues, it is not used routinely. Indocyanine green (ICG) near-infrared (NIR) fluorescent cholangiography is non invasive and provides real-time biliary images during surgery, which may improve the safety of single-incision cholecystectomy. This study aims to evaluate the efficacy and safety of this technique during single-site robotic cholecystectomy (SSRC). Methods: Patients presenting with symptomatic biliary gallstones without suspicion of common bile duct stones underwent SSRC with ICG-NIR fluorescent cholangiography using the da Vinci Fluorescence Imaging Vision System. During patient preparation, 2.5 mg of ICG was injected intravenously. During surgery, the biliary anatomy was imaged in real time, which guided dissection of Calot's triangle. Perioperative outcomes included biliary tree visualizations, operative time, conversion and complications rates, and length of hospital stay. Results: There were 45 cases between July 2011 and January 2012. All procedures were completed successfully; there were no conversions and at least one structure was visualized in each patient. The rates of visualization were 93 {\%} for the cystic duct, 88 {\%} for the common hepatic duct, and 91 {\%} for the common bile duct prior to Calot's dissection; after Calot's dissection, the rates were 97 {\%} for all three ducts. Mean hospital stay was 1.1 days and there were no bile duct injuries or any other major complications. Conclusion: Real-time high-resolution fluorescent imaging to identify the biliary tree anatomy during SSRC using the da Vinci Fluorescence Imaging Vision System was safe and effective.",
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AU - Priora, Fabio

AU - Bianchi, Paolo Pietro

AU - Lucido, Francesco Saverio

AU - Licciardello, Alessio

AU - Maglione, Valeria

AU - Grosso, Federica

AU - Quarati, Raul

AU - Ravazzoni, Ferruccio

AU - Lenti, Luca Matteo

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KW - Indocyanine green

KW - Near-infrared fluorescence

KW - Single-incision laparoscopic surgery

KW - Single-site robotic cholecystectomy

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