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

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

doi:10.1007/s00464-014-3677-5

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

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

Research output: Contribution to journal › Article › peer-review

110 Scopus citations

Abstract

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/m², 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.

Original language	English (US)
Pages (from-to)	368-375
Number of pages	8
Journal	Surgical endoscopy
Volume	29
Issue number	2
DOIs	https://doi.org/10.1007/s00464-014-3677-5
State	Published - Jan 14 2015
Externally published	Yes

Keywords

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

ASJC Scopus subject areas

Surgery

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10.1007/s00464-014-3677-5

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Osayi, S. N., Wendling, M. R., Drosdeck, J. M., Chaudhry, U. I., Perry, K. A., Noria, S. F., Mikami, D. J., Needleman, B. J., Muscarella, P., Abdel-Rasoul, M., Renton, D. B., Melvin, W. S., Hazey, J. W., & Narula, V. K. (2015). Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy. Surgical endoscopy, 29(2), 368-375. https://doi.org/10.1007/s00464-014-3677-5

Osayi, SN, Wendling, MR, Drosdeck, JM, Chaudhry, UI, Perry, KA, Noria, SF, Mikami, DJ, Needleman, BJ, Muscarella, P, Abdel-Rasoul, M, Renton, DB, Melvin, WS, Hazey, JW & Narula, VK 2015, 'Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy', Surgical endoscopy, vol. 29, no. 2, pp. 368-375. https://doi.org/10.1007/s00464-014-3677-5

@article{083dc9ef356e49fc9f83da6a817d3dd5,

title = "Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy",

abstract = "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{\textquoteright}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/m2, 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.",

keywords = "Biliary mapping, Fluorescence cholangiography, Indocyanine green, Intraoperative cholangiogram, Laparoscopic cholecystectomy, Near-infrared imaging",

author = "Osayi, {Sylvester N.} and Wendling, {Mark R.} and Drosdeck, {Joseph M.} and Chaudhry, {Umer I.} and Perry, {Kyle A.} and Noria, {Sabrena F.} and Mikami, {Dean J.} and Needleman, {Bradley J.} and Peter Muscarella and Mahmoud Abdel-Rasoul and Renton, {David B.} and Melvin, {W. Scott} and Hazey, {Jeffrey W.} and Narula, {Vimal K.}",

note = "Publisher Copyright: {\textcopyright} 2014, Springer Science+Business Media New York.",

year = "2015",

month = jan,

day = "14",

doi = "10.1007/s00464-014-3677-5",

language = "English (US)",

volume = "29",

pages = "368--375",

journal = "Surgical endoscopy",

issn = "0930-2794",

publisher = "Springer New York",

number = "2",

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TY - JOUR

T1 - Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy

AU - Osayi, Sylvester N.

AU - Wendling, Mark R.

AU - Drosdeck, Joseph M.

AU - Chaudhry, Umer I.

AU - Perry, Kyle A.

AU - Noria, Sabrena F.

AU - Mikami, Dean J.

AU - Needleman, Bradley J.

AU - Muscarella, Peter

AU - Abdel-Rasoul, Mahmoud

AU - Renton, David B.

AU - Melvin, W. Scott

AU - Hazey, Jeffrey W.

AU - Narula, Vimal K.

PY - 2015/1/14

Y1 - 2015/1/14

N2 - 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/m2, 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.

AB - 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/m2, 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.

KW - Biliary mapping

KW - Fluorescence cholangiography

KW - Indocyanine green

KW - Intraoperative cholangiogram

KW - Laparoscopic cholecystectomy

KW - Near-infrared imaging

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AN - SCOPUS:84927520980

SN - 0930-2794

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SP - 368

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JO - Surgical endoscopy

JF - Surgical endoscopy

IS - 2

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

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