Fluorescent cholangiography: An up-to-date overview twelve years after the first clinical application

Antonio Pesce, Gaetano Piccolo, Francesca Lecchi, Nicolò Fabbri, Michele Diana, Carlo Vittorio Feo, Antonio Pesce, Gaetano Piccolo, Francesca Lecchi, Nicolò Fabbri, Michele Diana, Carlo Vittorio Feo

Abstract

Laparoscopic cholecystectomy (LC) is one of the most frequently performed gastrointestinal surgeries worldwide. Bile duct injury (BDI) represents the most serious complication of LC, with an incidence of 0.3%-0.7%, resulting in significant perioperative morbidity and mortality, impaired quality of life, and high rates of subsequent medico-legal litigation. In most cases, the primary cause of BDI is the misinterpretation of biliary anatomy, leading to unexpected biliary lesions. Near-infrared fluorescent cholangiography is widely spreading in clinical practice to delineate biliary anatomy during LC in elective and emergency settings. The primary aim of this article was to perform an up-to-date overview of the evolution of this method 12 years after the first clinical application in 2009 and to highlight all advantages and current limitations according to the available scientific evidence.

Keywords: Bile duct injury; Biliary anatomy; Fluorescent cholangiography; Indocyanine green; Laparoscopic cholecystectomy.

Conflict of interest statement

Conflict-of-interest statement: The corresponding author declares that the manuscript has been submitted on behalf of all authors. All authors declare that they have no competing interests.

©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

Figures

Figure 1
Figure 1
Intra-operative real-time identification of biliary structures in a cirrhotic patient, with visible light to the left and NIRF-C to the right. A: Pre-dissection visualization of biliary anatomy; B: After complete dissection. One can observe the posterior implantation of the cystic duct on the common hepatic duct. CD: Cystic duct; CHD: Common hepatic duct; CBD: Common bile duct.
Figure 2
Figure 2
Classical extrahepatic biliary anatomy with identification of the right and left hepatic ducts using near-infrared fluorescent cholangiography. CD: Cystic duct; CHD: Common hepatic duct; RHD: Right hepatic duct; LHD: Left hepatic duct.
Figure 3
Figure 3
Identification of cystic duct stones by means of fluorescence.

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