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Utility of near infrared fluorescent cholangiography in detecting biliary structures during challenging minimally invasive cholecystectomy.
Piccolo, Gaetano; Barabino, Matteo; Lecchi, Francesca; Formisano, Giampaolo; Salaj, Adelona; Piozzi, Guglielmo Niccolò; Bianchi, Paolo Pietro.
Afiliación
  • Piccolo G; General Surgery Unit, Department of Health Sciences (DISS), University of Milan, San Paolo Hospital, Via Antonio Di Rudinì 8, Milan, 20142, Italy. gpiccolo1983@gmail.com.
  • Barabino M; General Surgery Unit, Department of Health Sciences (DISS), University of Milan, San Paolo Hospital, Via Antonio Di Rudinì 8, Milan, 20142, Italy.
  • Lecchi F; General Surgery Unit, Department of Health Sciences (DISS), University of Milan, San Paolo Hospital, Via Antonio Di Rudinì 8, Milan, 20142, Italy.
  • Formisano G; General Surgery Unit, Department of Health Sciences (DISS), University of Milan, San Paolo Hospital, Via Antonio Di Rudinì 8, Milan, 20142, Italy.
  • Salaj A; General Surgery Unit, Department of Health Sciences (DISS), University of Milan, San Paolo Hospital, Via Antonio Di Rudinì 8, Milan, 20142, Italy.
  • Piozzi GN; Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
  • Bianchi PP; General Surgery Unit, Department of Health Sciences (DISS), University of Milan, San Paolo Hospital, Via Antonio Di Rudinì 8, Milan, 20142, Italy.
Langenbecks Arch Surg ; 408(1): 282, 2023 Jul 18.
Article en En | MEDLINE | ID: mdl-37462733
ABSTRACT

BACKGROUND:

Surgeons can minimize the risk of bile duct injury (BDI) during challenging mini-invasive cholecystectomy through technical standardization by means of a precise anatomical landmark identification (Critical View of Safety) and advanced technology for biliary visualization. Among these systems, the adoption of magnified stereoscopic 3-dimensional view provided by robotic platforms and near infrared fluorescent cholangiography (NIRF-C) is the most promising.

METHODS:

In this prospective cohort study, we evaluated all consecutive minimally invasive cholecystectomies (laparoscopic and robotic) performed with NIRF-C between May 2022 and January 2023 at General Surgery Unit, Department of Health Sciences, University of Milan, San Paolo Hospital (Milan, Italy). Inclusions criteria were as follows (1) acute cholecystitis (emergency group), (2) history of chronic cholecystitis or complicated cholelithiasis (deferred urgent group), (3) difficult cases (patients affected by cirrhosis, with scleroatrophic gallbladder or BMI > 35 kg/m2). For each group, the detection rate and visualization order of the main biliary structures were reported (cystic duct, CD; common hepatic duct, CHD; common bile duct, CBD; and CD-CHD junction).

RESULTS:

A total of 101 consecutive patients were enrolled, including 83 laparoscopic and 18 robotic cholecystectomies. All patients were stratified into three subgroups (a) emergency group (n = 33, 32.7%), (b) deferred urgent group (n = 46, 45.5%), (c) difficult group (n = 22, 21.8%). Visualization of at least one biliary structure was possible in 94.1% of cases (95/101). Interestingly, all four main structures were detected in 43.6% of cases (44/101). The CD was the structure identified most frequently, being recognized in 91/101 patients (90.1%), followed by CBD (83.2%), CHD (62.4%), and CD-CHD junction (52.5%). In the subset of patients that underwent emergency surgery for AC, the CD-CHD confluence was identified in only 45.5% of cases. However, early and precise identification of CBD (75.8%) and CD (87.9%) allowed safe isolation, clipping, and transection of the cystic duct. In the deferred urgent group, the CBD and the CD were easily identified as first structure in a high percentage of cases (65.2% and 41.3% respectively), whereas the CD-CHD junction was the third structure to be identified in 67.4% of cases, the highest value among the three subgroups. In the difficult group, NIRF-C did not prove to be a useful tool for biliary visualization. The rates of failure of visualization were elevated CBD (27.3%), CD (18.2%), CHD (54.5%), and CD-CHD (68.2%).

CONCLUSIONS:

NIRF-C is a powerful real-time diagnostic tool to detect CBD and CD during minimally invasive cholecystectomy, especially when inflammation due to acute or chronic cholecystitis subverted the anatomy of the hepatoduodenal ligament.
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Texto completo: 1 Colección: 01-internacional Asunto principal: Colecistitis / Colecistectomía Laparoscópica Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Langenbecks Arch Surg Año: 2023 Tipo del documento: Article País de afiliación: Italia

Texto completo: 1 Colección: 01-internacional Asunto principal: Colecistitis / Colecistectomía Laparoscópica Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Langenbecks Arch Surg Año: 2023 Tipo del documento: Article País de afiliación: Italia