scholarly journals Fluorescent Imaging With Indocyanine Green During Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury

2017 ◽  
Vol 24 (3) ◽  
pp. 245-252 ◽  
Author(s):  
Marjolein Ankersmit ◽  
Dieuwertje A. van Dam ◽  
Anne-Sophie van Rijswijk ◽  
Baukje van den Heuvel ◽  
Jurriaan B. Tuynman ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Indocyanine Green ◽  
Bile Duct Injury ◽  
Near Infrared ◽  
Fluorescent Imaging ◽  
Added Value ◽  
Optimal Dosage ◽  
Nir Light ◽  
Increased Risk

Background. Although rare, injury to the common bile duct (CBD) during laparoscopic cholecystectomy (LC) can be reduced by better intraoperative visualization of the cystic duct (CD) and CBD. The aim of this study was to establish the efficacy of early visualization of the CD and the added value of CBD identification, using near-infrared (NIR) light and the fluorescent agent indocyanine green (ICG), in patients at increased risk of bile duct injury. Materials and Methods. Patients diagnosed with complicated cholecystitis and scheduled for LC were included. The CBD and CD were visualized with NIR light before and during dissection of the liver hilus and at critical view of safety (CVS). Results. Of the 20 patients originally included, 2 were later excluded due to conversion. In 6 of 18 patients, the CD was visualized early during dissection and prior to imaging with conventional white light. The CBD was additionally visualized with ICG-NIR in 7 of 18 patients. In 1 patient, conversion was prevented due to detection of the CD and CBD with ICG-NIR. Conclusions. Early visualization of the CD or additional identification of the CBD using ICG-NIR in patients with complicated cholecystolithiasis can be helpful in preventing CBD injury. Future studies should attempt to establish the optimal dosage and time frame for ICG administration and bile duct visualization with respect to different gallbladder pathologies.

scholarly journals P11: NEAR INFRARED FLUORESCENT CHOLANGIOGRAPHY IN LAPAROSCOPIC CHOLECYSTECTOMY: A SINGLE CENTRE FEASIBILITY STUDY. THE OPTIMUM DOSING REGIME, LIMITATIONS AND WHERE NEXT?

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
G Armstrong ◽  
G Toogood ◽  
DG Jayne ◽  
AM Smith
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Indocyanine Green ◽  
Feasibility Study ◽  
Near Infrared ◽  
Intravenous Dose ◽  
Structure Identification ◽  
Dosing Regimen ◽  
Single Centre ◽  
Fluorescent Cholangiography

Abstract Introduction This study explored near-infrared fluorescent cholangiography (NIRFC) with Indocyanine Green (ICG) during laparoscopic cholecystectomy (LC) surgery in a tertiary referral hepatobiliary unit. ICG binds to albumin and is excreted in bile. NIRFC utilises the fluorescent and excretory properties of ICG to provide dynamic extrahepatic bile duct mapping during LC. Method Non-randomised single centre feasibility study. Twenty-two participants were sequentially allocated to four dosing subgroups prior to NIRFC assisted LC. Each received a single intravenous dose of ICG prior to LC with the Stryker Novadaq NIR laparoscope. The biliary anatomy was assessed with NIRFC at three time-points, detection was compared to radiological cholangiogram where available and surgeon satisfaction was assessed. Result Eight participants received 2.5mg ICG 20-40min before surgery, four 0.25mg/kg 20-40min, five 90min – 180min and five 12 – 36 hour pre-operatively. Average age 50 years (S.D±15), BMI 27.5m2 (S.D±3.6), 6/22 were acute LC procedures. The prolonged dosing interval produced increased extrahepatic biliary structure identification (p = 0.016), reduced noise to signal ratio and was consistently preferred by the operating surgeon. NIRFC was inferior to radiological cholangiogram (n = 10) (p = 0.014) for bile duct mapping. We observed iatrogenic bile spillage saturating the field and obscuring structure differentiation and peri-hilar inflammation impeding fluorescent detection in acute LC. Conclusion The dosing regimen 0.25mg/kg ICG 12 to 36 hours prior to surgery provides optimum NIRFC structure visualisation. Fluorescent tissue penetrance is limited in acute peri-hilar inflammation. More research in to the efficiency of NIRFC in emergency LC is required. Take-home message An intravenous dose of 0.25mg/kg of Indocyanine Green 12 to 36 hours before surgery is the optimum dosing regimen for increased extra-hepatic bile duct structures with near infrared fluorescent cholangiography. The role of NIRFC in acute laparoscopic cholecystectomy surgery remains ill-defined.

Native Americans Have an Increased Risk of Major Bile Duct Injury during Laparoscopic Cholecystectomy: Results from a Statewide Analysis

2017 ◽  
Vol 83 (4) ◽  
pp. 110-112
Author(s):  
Alissa Greenbaum ◽  
Eyas Alkhalili ◽  
Li Luo ◽  
Ashwani Rajput ◽  
Itzhak Nir
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Native Americans ◽  
Bile Duct Injury ◽  
Increased Risk

scholarly journals Biliary Complications Post Laparoscopic Cholecystectomy: Mechanism, Preventive Measures, and Approach to Management: A Review

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Norman Oneil Machado
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Preventive Measures ◽  
Hepatic Duct ◽  
Biliary Complications ◽  
Common Hepatic Duct ◽  
Management Approach ◽  
Open Approach ◽  
Increased Risk

Laparoscopic cholecystectomy has emerged as a gold standard therapeutic option for the management of symptomatic cholelithiasis. However, adaptation of LC is associated with increased risk of complications, particularly bile duct injury ranging from 0.3 to 0.6%. Occurrence of BDI results in difficult reconstruction, prolonged hospitalization, and high risk of long-term complications. Therefore, more emphasis is placed on preventing these complications. In addition to adequate training, several techniques have been proposed to prevent bile duct injury including use of 30∘ scope, adequate delineation of structures in Calot's triangle (critical view), avoidance of diathermy close to common hepatic duct, and intraoperative cholangiogram, and to maintain a low threshold to conversion to open approach when uncertain. Management of Bile duct injury depends on the nature of injury, time of detection, and the expertise available, and would range from simple subhepatic drainage to Roux-en-Y hepaticojejunostomy particularly performed at specialised centers. This article based on the literature review aims to review the biliary complications following laparoscopic cholecystectomy with reference to its mechanism , preventive measures to be taken, and the management approach.

scholarly journals Iatrogenic Bile Duct Injuries: An Overview and A Review of Literature

2021 ◽  
Vol 07 (01) ◽  
pp. 037-043
Author(s):  
Vinoth M. ◽  
Abhijit Joshi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Surgical Procedures ◽  
Surgical Repair ◽  
Review Of Literature ◽  
Bile Duct Injuries ◽  
Iatrogenic Bile Duct Injury

Abstract​ Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures worldwide. Iatrogenic bile duct injury (IBDI) is a serious complication of LC and has an incidence of 0.3 to 0.7%. Since it is associated with a significant and potentially lifelong morbidity as well as mortality, diagnosing IBDI as early as possible is of paramount importance. Management of bile duct injuries and prognosis of their surgical repair depend on the timing of its recognition, type and the extent of the injury. In this paper, we present a case of IBDI and attempt to discuss all its dimensions.

Iatrogenic Bile Duct Injury. A Significant Surgical Problem. Assessment of Treatment Outcomes in the Department's Own Material

2015 ◽  
Vol 86 (12) ◽  
Author(s):  
Adam Bobkiewicz ◽  
łukasz Krokowicz ◽  
Tomasz Banasiewicz ◽  
Tomasz Kościński ◽  
Maciej Borejsza-Wysocki ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Retrospective Analysis ◽  
Bile Duct Injury ◽  
Clinical Symptoms ◽  
Open Cholecystectomy ◽  
Multidisciplinary Treatment ◽  
Laparoscopic Technique ◽  
Primary Surgery ◽  
Iatrogenic Bile Duct Injury

AbstractIatrogenic bile duct injuries (BDI) are still a challenging diagnostic and therapeutic problem. With the introduction of the laparoscopic technique for the treatment of cholecystolithiasis, the incidence of iatrogenic BDI increased.was a retrospective analysis of 69 patients treated at the department due to iatrogenic BDI in the years 2004-2014.. In this paper, we presented the results of a retrospective analysis of 69 patients treated at the Department due to iatrogenic BDI in the years 2004-2014. The data were analysed in terms of age, sex, type of biliary injury, clinical symptoms, the type of repair surgery, the time between the primary surgery and the BDI management, postoperative complications and duration of hospital stay.. 82.6% of BDI occurred during laparoscopic cholecystectomy, 8.7% occurred during open cholecystectomy, whereas 6 cases of BDI resulted from surgeries conducted for other indications. In order to assess the degree of BDI, Bismuth and Neuhaus classifications were used (for open and laparoscopic cholecystectomy respectively). 84.1% of patients with confirmed BDI, were transferred to the Department from other hospitals. The average time between the primary surgery and reoperation was 6.2 days (SD 4). The most common clinical symptom was biliary fistula observed in 78.3% of patients. In 28 patients, unsuccessful attempts to manage BDI were made prior to the admission to the Department in other centres. The repair procedure was mainly conducted by laparotomy (82.6%) and by the endoscopic approach (15.9%). Hepaticojejunostomy was the most common type of reconstruction following BDI (34.7%).. The increase in the rate of iatrogenic bile duct injury remains a challenging surgical problem. The management of BDI should be multidisciplinary treatment. Referring patients with both suspected and confirmed iatrogenic BDI to tertiary centres allows more effective treatment to be implemented.

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