Pesce A, Piccolo G, Lecchi F, Fabbri N, Diana M, Feo CV. Fluorescent cholangiography: An up-to-date overview twelve years after the first clinical application. World J Gastroenterol 2021; 27(36): 5989-6003 [PMID: 34629815 DOI: 10.3748/wjg.v27.i36.5989]
Corresponding Author of This Article
Antonio Pesce, MD, PhD, Research Fellow, Surgeon, Department of Surgery, Section of General Surgery, Ospedale del Delta, Azienda USL of Ferrara, University of Ferrara, Via Valle Oppio 2, Lagosanto (FE), Ferrara 44023, Italy. antonio.pesce@ausl.fe.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Frontier
Open-Access Policy of This Article
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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Sep 28, 2021; 27(36): 5989-6003 Published online Sep 28, 2021. doi: 10.3748/wjg.v27.i36.5989
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, Nicolò Fabbri, Carlo Vittorio Feo, Department of Surgery, Section of General Surgery, Ospedale del Delta, Azienda USL of Ferrara, University of Ferrara, Ferrara 44023, Italy
Gaetano Piccolo, Francesca Lecchi, Department of Health Sciences, University of Milan, Unit of Hepato-Bilio-Pancreatic and Digestive Surgery, San Paolo Hospital, Milano 20142, Italy
Michele Diana, Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, IRCAD, Research Institute Against Digestive Cancer, ICUBE lab, PHOTONICS for Health, University of Strasbourg, Strasbourg Cedex F-67091, France
Author contributions: Pesce A and Piccolo G designed the research; Pesce A, Piccolo G, Fabbri N, and Lecchi F researched and wrote the manuscript; Diana M and Feo CV supervised the paper; all authors have read and approved the final manuscript.
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.
Open-Access: This article is an open-access article that 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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Antonio Pesce, MD, PhD, Research Fellow, Surgeon, Department of Surgery, Section of General Surgery, Ospedale del Delta, Azienda USL of Ferrara, University of Ferrara, Via Valle Oppio 2, Lagosanto (FE), Ferrara 44023, Italy. antonio.pesce@ausl.fe.it
Received: April 15, 2021 Peer-review started: April 15, 2021 First decision: July 1, 2021 Revised: July 10, 2021 Accepted: August 30, 2021 Article in press: August 30, 2021 Published online: September 28, 2021
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.
Core Tip: Fluorescence image-guided surgery is one of the most recent innovations in laparoscopic and robotic surgery. The visualization of biliary anatomy using fluorescence during surgery is becoming one of the most promising frontier approaches in minimally invasive surgery. This novel method is a powerful tool to detect biliary variants that could guide surgeons during dissection to prevent major bile duct lesions, and it has enormous potential to be considered the gold standard during all cholecystectomies. The up-to-date overview of this method confirms the efficacy of indocyanine green fluorescence cholangiography in detecting biliary anatomy, its importance as a teaching tool for young surgeons, and the effects on the reduction of conversion rate and bile duct injury, even if further considerable research remains necessary to optimize its use.
