Combined vascular and biliary fluorescence imaging in laparoscopic cholecystectomy.

BACKGROUND: Bile duct injury in patients undergoing laparoscopic is a rare but serious complication. Concomitant vascular injury worsens outcome of bile duct injury repair. Near-infrared fluorescence imaging indocyanine green (ICG) is a promising, innovative, and noninvasive the intraoperative identification of biliary and vascular anatomy during cholecystectomy. This study assessed the practical application of vascular and biliary fluorescence imaging in laparoscopic gallbladder early biliary tract delineation and arterial anatomy confirmation. Patients undergoing elective laparoscopic cholecystectomy were enrolled prospective, single-institutional study. To delineate the major bile arteries, a dedicated laparoscope, offering both conventional and imaging, was used. ICG (2.5 mg) was administered intravenously induction of anesthesia and in half of the patients repeated at critical view of safety for concomitant arterial imaging. During the base of the gallbladder and the cystic duct, the extrahepatic bile visualized. Intraoperative recognition of the biliary structures was at set time points, as well as visualization of the cystic artery after ICG administration. RESULTS: Thirty patients were included. ICG was the liver and bile ducts within 20 minutes after injection and remained approximately 2 h, using the ICG-filter of the laparoscope. In most common bile duct (83 %) and cystic duct (97 %) could be identified earlier than with conventional camera mode. In 13 of 15 patients (87 %), confirmation of the cystic artery was obtained successfully after repeat injection. No per- or postoperative complications occurred as a ICG use. CONCLUSION: Biliary and vascular fluorescence imaging in cholecystectomy is easily applicable in clinical practice, can be earlier visualization of the biliary tree, and is useful for the the arterial anatomy.