New Imaging Method Facilitates Gall Bladder Removal

Real-time near-infrared fluorescence cholangiography (NIRFC) can help image the bile ducts during gallbladder removal surgeries, according to a new study.

Researchers at the University of California Los Angeles (UCLA; USA) conducted a prospective study involving 37 patients undergoing laparoscopic biliary and hepatic operations who were administered intravenous indocyanine green (ICG) for NIRFC. The patients were administered with different doses and times—ranging from 10 to 180 minutes—from ICG injection to visualization. The porta hepatis vein and biliary structures were then examined using a dedicated laparoscopic system equipped to detect NIRFC, and quantitatively analyzed using a scoring system.

The results showed that visualization of the extrahepatic biliary tract improved with increasing doses of ICG, and was also significantly better with increased time after ICG administration; quantitative measures also improved with both dose and time. The results suggest that a dose of 0.25 mg/kg administered at least 45 minutes prior to visualization is optimal for intraoperative anatomical identification of the extrahepatic biliary anatomy. The study was published on March 10, 2016, in Surgical Innovations.

“Injuries to the bile ducts, which carry bile from the liver to the intestines, are rare; but when they do occur, the outcomes can be quite serious and cause life-long consequences,” said lead author Ali Zarrinpar, MD, PhD. “Gallbladder removals are one of the most litigated cases in general surgery because of these injuries. Any technique that can reduce the rate of bile duct injury and increase the safety of the operation is good for patients and for surgeons.”

The gallbladder and liver can be hard to access and visualize when the areas around them are inflamed or surrounded by fat. Using a conventional imaging technique, in which the bile ducts are not clearly delineated, injuries to the ducts can occur. But when ICG is taken up by the liver and excreted into the bile, laparoscopic devices can detect the fluorescence in the bile ducts and superimpose that image onto a conventional white light image. The augmented image improves the surgeons' visualization, making it easier for them to identify the appropriate bile duct anatomy.

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