Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2015; 21(25): 7877-7883
Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7877
Utility of fluorescent cholangiography during laparoscopic cholecystectomy: A systematic review
Antonio Pesce, Gaetano Piccolo, Gaetano La Greca, Stefano Puleo
Antonio Pesce, Gaetano La Greca, Stefano Puleo, Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy
Gaetano Piccolo, Department of Surgery, University of Catania, 95123 Catania, Italy
Author contributions: Pesce A designed the research; Piccolo G performed the research; Pesce A and Piccolo G analyzed the data; Pesce A and Piccolo G wrote the paper; La Greca G and Puleo S supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Antonio Pesce, MD, Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Via S. Sofia 84, 95123 Catania, Italy.
Telephone: +39-32-86680943 Fax: +39-0953782912
Received: February 4, 2015
Peer-review started: February 6, 2015
First decision: March 10, 2015
Revised: April 16, 2015
Accepted: May 27, 2015
Article in press: May 27, 2015
Published online: July 7, 2015

AIM: To verify the utility of fluorescent cholangiography for more rigorous identification of the extrahepatic biliary system.

METHODS: MEDLINE and PubMed searches were performed using the key words “fluorescent cholangiography”, “fluorescent angiography”, “intraoperative fluorescent imaging”, and “laparoscopic cholecystectomy” in order to identify relevant articles published in English, French, German, and Italian during the years of 2009 to 2014. Reference lists from the articles were reviewed to identify additional pertinent articles. For studies published in languages other than those mentioned above, all available information was collected from their English abstracts. Retrieved manuscripts (case reports, reviews, and abstracts) concerning the application of fluorescent cholangiography were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. In contrast to classic meta-analyses, statistical analysis was performed where the outcome was calculated as the percentages of an event (without comparison) in pseudo-cohorts of observed patients.

RESULTS: A total of 16 studies were found that involved fluorescent cholangiography during standard laparoscopic cholecystectomies (n = 11), single-incision robotic cholecystectomies (n = 3), multiport robotic cholecystectomy (n = 1), and single-incision laparoscopic cholecystectomy (n = 1). Overall, these preliminary studies indicated that this novel technique was highly sensitive for the detection of important biliary anatomy and could facilitate the prevention of bile duct injuries. The structures effectively identified before dissection of Calot’s triangle included the cystic duct (CD), the common hepatic duct (CHD), the common bile duct (CBD), and the CD-CHD junction. A review of the literature revealed that the frequencies of detection of the extrahepatic biliary system ranged from 71.4% to 100% for the CD, 33.3% to 100% for the CHD, 50% to 100% for the CBD, and 25% to 100% for the CD-CHD junction. However, the frequency of visualization of the CD and the CBD were reduced in patients with a body mass index > 35 kg/m2 relative to those with a body mass index < 35 kg/m2 (91.0% and 64.0% vs 92.3% and 71.8%, respectively).

CONCLUSION: Fluorescent cholangiography is a safe procedure enabling real-time visualization of bile duct anatomy and may become standard practice to prevent bile duct injury during laparoscopic cholecystectomy.

Keywords: Extrahepatic biliary system, Laparoscopic cholecystectomy, Bile duct injury, Biliary anomalies, Fluorescent cholangiography

Core tip: Fluorescent cholangiography (FC) is a safe and effective novel procedure that enables real-time visualization of the biliary system. Intraoperative FC has been successfully performed during mini-invasive cholecystectomies in various studies, including standard laparoscopic cholecystectomies, single incision cholecystectomies, and robotic cholecystectomies. The primary aim of this review is to verify the utility of this technique for more rigorous identification of the extrahepatic biliary system in order to prevent bile duct injuries intraoperatively. The second aim is to illuminate potential benefits and limitations in the application of FC.