Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7877
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.
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.