Fluorescent cholangiography in a mouse model: An innovative method for improved laparoscopic identification of the biliary anatomy

B. M. Stiles, P. S. Adusumilli, A. Bhargava, Y. Fong

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Real-time imaging of the biliary anatomy may facilitate safe and timely completion of laparoscopic cholecystectomy. This study sought to determine whether the unique autofluorescent properties of bile could facilitate intraoperative identification of the biliary anatomy in mice using fluorescent cholangiography. Methods: Fluorimetry was performed on samples of mouse bile to determine excitation and emission spectra. For seven mice, chevron laparotomy was performed, followed by liver retraction to expose the porta hepatis. Using stereomicroscopy, photographs were taken in brightfield and fluorescent modes without a change in depth or focus. Six surgical residents evaluated the pictures and identified the gallbladder, cystic duct, common bile duct, and whether the cystic duct joined the right hepatic duct or the common bile duct. Results: Fluorimetry demonstrated autofluorescence of bile at an excitation wavelength of 475 nm. Intense emission was observed at 480 nm. At these settings, fluorescent stereomicroscopy easily identified the gallbladder and biliary tree in mice. This technique decreased diagnostic errors of the biliary anatomy 11-fold (2% vs 22%; p < 0.01), as compared with brightfield visualization. Fluorescent stereomicroscopy also was used to diagnose bile leak, obstruction, and complex anatomy. Using a prototype 5-mm laparoscope equipped with fluorescent filters, the results were reproduced. Conclusions: Fluorescent cholangiography based solely on the autofluorescence of bile may facilitate real-time identification of the biliary anatomy during laparoscopic procedures, without the need for extraneous dye administration or the use of radiography. This technique has the potential to decrease the rate of iatrogenic biliary tract injuries during laparoscopic cholecystectomy.

Original languageEnglish (US)
Pages (from-to)1291-1295
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume20
Issue number8
DOIs
StatePublished - Aug 2006

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Cholangiography
Bile
Anatomy
Cystic Duct
Fluorometry
Laparoscopic Cholecystectomy
Common Bile Duct
Biliary Tract
Gallbladder
Laparoscopes
Common Hepatic Duct
Diagnostic Errors
Radiography
Laparotomy
Coloring Agents
Liver
Wounds and Injuries

Keywords

  • Bile duct injuries
  • Laparoscopic cholecystectomy
  • Surgical injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Fluorescent cholangiography in a mouse model : An innovative method for improved laparoscopic identification of the biliary anatomy. / Stiles, B. M.; Adusumilli, P. S.; Bhargava, A.; Fong, Y.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 20, No. 8, 08.2006, p. 1291-1295.

Research output: Contribution to journalArticle

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