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Thammineedi SR, Patnaik SC, Reddy P, Shukla S, Vashist YK, Nusrath S. Feasibility of Indocyanine Green Fluorescent Cholangiography Via Inguinal Nodal Injection Approach in Upper Gastrointestinal Oncological Surgeries. A Pilot Study. Indian J Surg Oncol 2024; 15:946-954. [PMID: 39555375 PMCID: PMC11564417 DOI: 10.1007/s13193-024-02005-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/22/2024] [Indexed: 11/19/2024] Open
Abstract
Fluorescent cholangiography (FC) with indocyanine green (ICG) is an alternative to intraoperative cholangiography (IOC) for visualizing the biliary tract during surgery. This pilot study assessed the feasibility of ICG-FC using inguinal nodal injection in patients undergoing upper gastrointestinal cancer surgery. Under sonographic guidance, ICG was injected into inguinal nodes bilaterally (each side 2.5 mg, total 5 mg) after induction of anesthesia. Laparoscopic cholecystectomy (CHE) and laparoscopic hepatoduodenal ligament clearance (HDL) were performed in 24 cases. ICG-FC was utilized for real-time visualization of extrahepatic biliary anatomy. In CHE cases, ICG-FC provided 100% visualization of the gall bladder (GB), common bile duct (CBD), common hepatic duct (CHD), cystic duct (CD), and CD-CBD junction. For HDL, the visualization rates were 100% for the GB, CHD, and CBD, but only 50% for the undissected CD. Fluorescence appeared in the biliary tree soon after injection and remained throughout the duration of surgery with minimal interference from background hepatic fluorescence. No adverse reactions to ICG were observed. ICG-FC via the inguinal nodal route is safe and feasible, enabling real-time dissection of the calot's triangle and hepatoduodenal ligament. It offers reliable visualization of key biliary structures, showing promise as an alternative to IOC in upper gastrointestinal cancer surgeries.
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Affiliation(s)
- Subramanyeshwar Rao Thammineedi
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana Pin Code 500034 India
| | - Sujit Chyau Patnaik
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana Pin Code 500034 India
| | - Pratap Reddy
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana Pin Code 500034 India
| | - Srijan Shukla
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana Pin Code 500034 India
| | - Yogesh Kumar Vashist
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Syed Nusrath
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana Pin Code 500034 India
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Harada K, Yamana I, Uemoto Y, Kawamura Y, Fujikawa T. The Hanging Strap Method: A Safe and Easy-to-Use Surgical Technique for Surgeons-in-Training Performing Difficult Laparoscopic Cholecystectomy. Cureus 2024; 16:e66739. [PMID: 39280499 PMCID: PMC11393519 DOI: 10.7759/cureus.66739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2024] [Indexed: 09/18/2024] Open
Abstract
Introduction Surgeons-in-training (SIT) perform laparoscopic cholecystectomy (LC); however, it is challenging to complete the procedure safely in difficult cases. We present a surgical technique during difficult LC, which we named the hanging strap method. Methods We retrospectively compared the perioperative outcomes between patients undergoing difficult LC with the hanging strap method (HANGS, n = 34), and patients undergoing difficult LC without the hanging strap method (non-HANGS, n = 56) from 2022 and 2024. Difficult LC was defined as cases classified as more than grade II cholecystitis by the Tokyo Guidelines 18 and cases when LC was undergoing over five days after the onset of cholecystitis. Results The proportion of SIT with post-graduate year (PGY) ≤ 7 was significantly higher in the HANGS group than in the non-HANGS group (82.4% vs. 33.9%, P < 0.001). The overall rate of bile duct injury (BDI), postoperative bile leakage and operative mortality were zero in the whole cohort. There were no significant differences between the HANGS and non-HANGS groups in background characteristics, operative time (122 min vs. 132 min, P = 0.830) and surgical blood loss (14 mL vs. 24 mL, P = 0.533). Conclusions Our findings suggested that the hanging strap method is safe and easy to use for difficult LC. We recommend that the current method be selected as one of the surgical techniques for SIT when performing difficult LC.
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Affiliation(s)
- Kei Harada
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
| | - Ippei Yamana
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
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Jha PK, Jaiswal P, Gera S, Kumari R, Kumar K, Darjee R, Pankaj D. Exploring the Advantages and Techniques of Intraoperative Transcholecystic Methylene Blue Injection in Laparoscopic Cholecystectomy. Cureus 2024; 16:e64205. [PMID: 39130894 PMCID: PMC11310644 DOI: 10.7759/cureus.64205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction With the use of advanced instruments and techniques, the reported incidence of bile duct injury is low; however, the actual frequency might be slightly higher than reported. Most surgeons might encounter bile duct injury or bile duct-related complications in their early training days. Nevertheless, with newer techniques and technologies, cases of bile duct injuries have been mostly observed in open cholecystectomy. The predominant cause of injury is the misinterpretation of the anatomy of the bile duct, cystic duct, or aberrant right sectoral hepatic duct. Laparoscopic cholecystectomy is currently the gold standard of therapy for cholecystitis. Materials and methods The study was conducted in the Department of General Surgery at the Indira Gandhi Institute of Medical Sciences in Patna, after obtaining clearance from the ethics committee. The duration of the study was one year. Results A total of 50 patients were enrolled in the study, whose ages ranged from 20 to 55 years. They were predominantly female. The mean operative time was 68.5 ± 8.7 minutes. There were no cases of conversion to an open procedure, bile duct injury, or biliary stricture. Conclusion The injection of methylene blue into the gallbladder fundus during laparoscopic cholecystectomy is a practical, affordable, and simple procedure that does not require any special equipment or radiation exposure for the improved delineation of the gallbladder and biliary system. The use of intraoperative methylene blue could be a low-cost and simple alternative for safe laparoscopic cholecystectomy.
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Affiliation(s)
- Pawan K Jha
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Pradeep Jaiswal
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Shitiz Gera
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Rinku Kumari
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Kaushalendra Kumar
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Rohit Darjee
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Deepak Pankaj
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
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Lim YP, Leow VM, Koong JK, Subramaniam M. Is there a role for routine intraoperative cholangiogram in diagnosing CBD stones in patients with normal liver function tests? A prospective study. Innov Surg Sci 2024; 9:37-45. [PMID: 38826633 PMCID: PMC11138406 DOI: 10.1515/iss-2023-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/19/2024] [Indexed: 06/04/2024] Open
Abstract
Objectives Cholecystectomy with or without intraoperative cholangiogram (IOC) is an accepted treatment for cholelithiasis. Up to 11.6 % of cholecystectomies have incidental common bile duct (CBD) stones on IOC and 25.3 % of undiagnosed CBD stones will develop life-threatening complications. These will require additional intervention after primary cholecystectomy, further straining the healthcare system. We seek to examine the role of IOC in patients with normal LFTs by evaluating its predictive values, intending to treat undiagnosed CBD stones and therefore ameliorate these issues. Methods All patients who underwent cholecystectomies with normal LFTs from October 2019 to December 2020 were prospectively enrolled. IOC was done, ERCPs were performed for filling defects and documented as "true positive" if ERCP was congruent with the IOC. "False positives" were recorded if ERCP was negative. "True negative" was assigned to normal IOC and LFT after 2 weeks of follow-up. Those with abnormal LFTs were subjected to ERCP and documented as "false negative". Sensitivity, specificity, and predictive values were calculated. Results A total of 180 patients were analysed. IOC showed a specificity of 85.5 % and a NPV of 88.1 % with an AUC of 73.7 %. The positive predictive value and sensitivity were 56.5 and 61.9 % respectively. Conclusions Routine IOC is a specific diagnostic tool with good negative predictive value. It is useful to exclude the presence of CBD stones when LFT is normal. It does not significantly prolong the length of hospitalization or duration of the cholecystectomy hence reducing the incidence of undetected retained stones and preventing its complications effectively.
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Affiliation(s)
- Yi Ping Lim
- Department of Surgery, University Malaya, Kuala Lumpur, Malaysia
| | - Voon Meng Leow
- USMMC, Bertam, Kepala Batas, USM, Penang, Malaysia
- Hepatobiliary Unit, Department of General Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Jun Kit Koong
- Department of Surgery, University Malaya, Kuala Lumpur, Malaysia
| | - Manisekar Subramaniam
- Hepatobiliary Unit, Department of General Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
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Symeonidis S, Mantzoros I, Anestiadou E, Ioannidis O, Christidis P, Bitsianis S, Zapsalis K, Karastergiou T, Athanasiou D, Apostolidis S, Angelopoulos S. Biliary Anatomy Visualization and Surgeon Satisfaction Using Standard Cholangiography versus Indocyanine Green Fluorescent Cholangiography during Elective Laparoscopic Cholecystectomy: A Randomized Controlled Trial. J Clin Med 2024; 13:864. [PMID: 38337557 PMCID: PMC10856121 DOI: 10.3390/jcm13030864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Intraoperative biliary anatomy recognition is crucial for safety during laparoscopic cholecystectomy, since iatrogenic bile duct injuries represent a fatal complication, occurring in up to 0.9% of patients. Indocyanine green fluorescence cholangiography (ICG-FC) is a safe and cost-effective procedure for achieving a critical view of safety and recognizing early biliary injuries. The aim of this study is to compare the perioperative outcomes, usefulness and safety of standard intraoperative cholangiography (IOC) with ICG-FC with intravenous ICG. Methods: Between 1 June 2021 and 31 December 2022, 160 patients undergoing elective LC were randomized into two equal groups: Group A (standard IOC) and group B (ICG-FC with intravenous ICG). Results: No significant difference was found between the two groups regarding demographics, surgery indication or surgery duration. No significant difference was found regarding the visualization of critical biliary structures. However, the surgeon satisfaction and cholangiography duration presented significant differences in favor of ICG-FC. Regarding the inflammatory response, a significant difference between the two groups was found only in postoperative WBC levels. Hepatic and renal function test results were not significantly different between the two groups on the first postoperative day, except for direct bilirubin. No statistically significant difference was noted regarding 30-day postoperative complications, while none of the complications noted included bile duct injury events. Conclusions: ICG-FC presents equivalent results to IOC regarding extrahepatic biliary visualization and postoperative complications. However, more studies need to be performed in order to standardize the optimal dose, timing and mode of administration.
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Affiliation(s)
- Savvas Symeonidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Ioannis Mantzoros
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Elissavet Anestiadou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Orestis Ioannidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Panagiotis Christidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Stefanos Bitsianis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Konstantinos Zapsalis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Trigona Karastergiou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Dimitra Athanasiou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Stylianos Apostolidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Stamatios Angelopoulos
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
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Ker CG. Hepatobiliary surgery in Taiwan: The past, present, and future. Part I; biliary surgery. FORMOSAN JOURNAL OF SURGERY 2024; 57:1-10. [DOI: 10.1097/fs9.0000000000000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2024] Open
Abstract
Abstract
In Taiwan, most surgical services were mainly provided by Japanese or Western surgeons before World War II. Tsuchiya Kunita first reported surgical treatment of gallstone diseases in 1915 in Taiwan. After World War II, experienced Japanese surgeons returned to Japan, and well-trained surgeons moved to Taiwan from different hospitals in Mainland China after 1949. In 1954, Liao had reported surgical gallstone diseases treated by cholecytostomy, cholecystectomy, and cholecystogastrostomy or cholecystoduodenostomy from National Taiwan University Hospital (Formos J Surg. 1954;53:833–4). By using of operative cholangiography, diagnosis and removal of intrahepatic stones could be done through choledochostomy reported first by Lee HC from National Defense Medical Center in 1966 and 1968 (Chin Med J ROC. 1966;13:301–8; Chin Med J ROC. 1968;15:124–34). Wei from the National Taiwan University Hospital reported the first left hepatectomy for treating hepatolithiasis on one patient among his series in 1971 (Formos J Surg. 1971;4:178–96). Treatments of hepatolithiasis were well analyzed by Wen and Lee from Triservice General Hospital and Veterans General Hospital in 1972 (Ann Surg. 1972;175:166–77). Hwang was the first to use choledochofiberscope for removing retained stones since 1974 reported from Show Chwan Memorial Hospital in 1978 (Am J Surg. 1978;139:860–4). The first laparoscopic cholecystectomy was performed by Huang from Taipei Cathay General Hospital in 1990 in Taiwan (J Formos Med Assoc. 1991;90:893–9). Nowadays, Taiwan hepatobiliary surgeons were extensively using either laparoscopic or robotic surgery for treatment of hepatobiliary diseases.
In conclusion, we should never forget the great contributions from many clinics in rural villages hosted by Christian or Catholicism organizations in Taiwan hundred years ago. We should express our appreciations to the history of the evolutions of biliary surgical skills. In Taiwan, a great surgeon today is always standing on the shoulders of our ancient giants, our surgical teachers.
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Xie Q, Yang M, Jiang K, Zhang L, Mao T, Gao F. Laparoscopic cholecystectomy assisted by combined intravenous and intracholecystic fluorescent cholangiography: a case report. J Int Med Res 2023; 51:3000605231216396. [PMID: 38064274 PMCID: PMC10710120 DOI: 10.1177/03000605231216396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
This case report describes a laparoscopic approach using fluorescence imaging guidance to treat gangrenous cholecystitis with perforation (GCP). A male patient in his early 60s presented with 3 days of right upper abdominal pain. Computed tomography and ultrasonography findings were consistent with a stone incarcerated in the gallbladder neck, GCP, and localized peritonitis. Percutaneous gallbladder drainage was initially performed, followed by laparoscopic cholecystectomy 7 days later, using combined intravenous and intracholecystic fluorescent cholangiography. This technique allowed visualization of the cystic and common bile ducts during surgery and enabled safe removal of the diseased gallbladder. The patient recovered well without complications, and reported no pain or discomfort at a 2-month follow-up.
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Affiliation(s)
- Qingyun Xie
- Department of Hepato-Pancreato-Biliary Surgery, the People’s Hospital of Leshan, Leshan, China
| | - Manyu Yang
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Kangyi Jiang
- Department of Hepato-Pancreato-Biliary Surgery, the People’s Hospital of Leshan, Leshan, China
| | - Ling Zhang
- Department of Hepato-Pancreato-Biliary Surgery, the People’s Hospital of Leshan, Leshan, China
| | - Tianyang Mao
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Fengwei Gao
- Department of Hepato-Pancreato-Biliary Surgery, the People’s Hospital of Leshan, Leshan, China
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Marchegiani F, Conticchio M, Zadoroznyj A, Inchingolo R, Memeo R, De'angelis N. Detection and management of bile duct injury during cholecystectomy. Minerva Surg 2023; 78:545-557. [PMID: 36883937 DOI: 10.23736/s2724-5691.23.09866-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Cholecystectomy represents one of the most performed surgical procedures. Bile duct injuries (BDIs) are a dangerous complication of this intervention. With the advent of the laparoscopy, the rate of BDIs showed a growing trend that was partially justified by the learning curve of this technique. EVIDENCE ACQUISITION A literature search was conducted on Embase, Medline, and Cochrane databases to identify studies published up to October 2022 that analyzed the intraoperative detection and management of BDIs diagnosed during cholecystectomy. EVIDENCE SYNTHESIS According to the literature, approximately 25% of BDIs is diagnosed during the laparoscopic cholecystectomy. In the clinical suspicion of BDI, an intraoperative cholangiography is performed to confirm it. Complimentary technology, such as near-infrared cholangiography, can be also adopted. Intraoperative ultrasound represents a useful tool to furtherly define the biliary and the vascular anatomy. The proper classification of the type of BDI allows to identify the correct treatment. When a good expertise in hepato-pancreato-biliary surgery is available, a direct repair is performed with good outcomes both in case of simple and complex lesions. When the local resources are limited or there is a lack of dedicated surgical experience, patient referral to a reference center shows better outcomes. In particular, complex vasculo-biliary injuries require a highly specialized treatment. The key elements to transfer the patients are a good documentation of the injury, a proper drainage of the abdomen, and an antibiotic therapy. CONCLUSIONS BDI management requires a proper diagnostic process and prompt treatment to reduce the morbidity and mortality of this feared complication occurring during cholecystectomy.
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Affiliation(s)
- Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Maria Conticchio
- Unit of Hepato-Pancreato-Biliary Surgery, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Alizée Zadoroznyj
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Nicola De'angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France -
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Temperley HC, O'Sullivan NJ, Grainger R, Bolger JC. Is the use of a routine intraoperative cholangiogram necessary in laparoscopic cholecystectomy? Surgeon 2023; 21:e242-e248. [PMID: 36710125 DOI: 10.1016/j.surge.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/20/2022] [Accepted: 01/08/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Although laparoscopic cholecystectomy (LC) has been standard of care for symptomatic gallstone disease for almost 30 years, the use of routine intraoperative cholangiogram (IOC) remains controversial. There are marked variations in the use IOC during LC internationally. Debate has continued about its benefit, in part because of inconsistent benefit, time, and resources required to complete IOC. This literature review is presented as a debate to outline the arguments in favour of and against routine IOC in laparoscopic cholecystectomy. METHODS A standard literature review of PubMed, Medline, OVID, EMBASE, CINHIL and Web of Science was performed, specifically for literature pertaining to the use of IOC or alternative intra-operative methods for imaging the biliary tree in LC. Two authors assembled the evidence in favour, and two authors assembled the evidence against. RESULTS From this controversies piece we found that there is little discernible change in the number of BDIs requiring repair procedures. Although IOC is associated with a small absolute reduction in bile duct injury, there are other confounding factors, including a change in laparoscopic learning curves. Alternative technologies such as intra-operative ultrasound, indocyanine green imaging, and increased access to ERCP may contribute to a reduction in the need for routine IOC. CONCLUSIONS In spite of 30 years of accumulating evidence, routine IOC remains controversial. As technology advances, it is likely that alternative methods of imaging and accessing the bile duct will supplant routine IOC.
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Affiliation(s)
| | | | - Richard Grainger
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
| | - Jarlath C Bolger
- Department of Surgery, Toronto General Hospital/University Health Network, Toronto, ON, Canada; Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Thomas AS, Gleit Z, Younan S, Genkinger J, Kluger MD. High rate of stone-related complications after stapling the cystic duct during laparoscopic cholecystectomy-an underrecognized risk. Surg Endosc 2023:10.1007/s00464-023-09947-2. [PMID: 36890412 DOI: 10.1007/s00464-023-09947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/12/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Laparoscopic staplers (LS) have been suggested as a safe alternative to metal clips in laparoscopic cholecystectomy when the cystic duct is too inflamed or wide for complete clip occlusion. We aimed to evaluate the perioperative outcomes of patients whose cystic ducts were controlled by LS and evaluate the risk factors for complications. METHODS Patients who underwent laparoscopic cholecystectomy with LS used to control the cystic duct from 2005 to 2019 were retrospectively identified from an institutional database. Patients were excluded for open cholecystectomy, partial cholecystectomy, or cancer. Potential risk factors for complications were assessed using logistic regression analysis. RESULTS Among 262 patients, 191 (72.9%) were stapled for size and 71 (27.1%) for inflammation. In total, 33 (16.3%) patients had Clavien-Dindo grade ≥ 3 complications, with no significant difference when surgeons chose to staple for duct size versus inflammation (p = 0.416). Seven patients had bile duct injury. A large proportion had Clavien-Dindo grade ≥ 3 postoperative complications specifically related to bile duct stones [n = 29 (11.07%)]. Intraoperative cholangiogram was protective against postoperative complications [odds ratio (OR) = 0.18 (p = 0.022)]. CONCLUSION Whether these high complication rates reflect a technical issue with stapling, more challenging anatomy, or worse disease, findings question whether the use of LS during laparoscopic cholecystectomy is truly a safe alternative to the already accepted methods of cystic duct ligation and transection. Based on these findings, an intraoperative cholangiogram should be performed when considering a linear stapler during laparoscopic cholecystectomy to: (1) ensure the biliary tree is free of stones; (2) prevent inadvertent transection of the infundibulum rather than the cystic duct; and, (3) allow opportunity for safe alternative strategies when an IOC is not able to confirm anatomy. Otherwise, surgeons employing LS devices should be aware that patients are at higher risk for complications.
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Affiliation(s)
- Alexander S Thomas
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
- Division of GI and Endocrine Surgery, Surgery Resident and Postdoctoral Research Fellow, New York Presbyterian Hospital, 8th Floor, Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA.
| | - Zachary Gleit
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie Younan
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeanine Genkinger
- Department of Epidemiology, Herbert Irving Comprehensive Cancer Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Michael D Kluger
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Kovács N, Németh D, Földi M, Nagy B, Bunduc S, Hegyi P, Bajor J, Müller KE, Vincze Á, Erőss B, Ábrahám S. Selective intraoperative cholangiography should be considered over routine intraoperative cholangiography during cholecystectomy: a systematic review and meta-analysis. Surg Endosc 2022; 36:7126-7139. [PMID: 35794500 PMCID: PMC9485186 DOI: 10.1007/s00464-022-09267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Decades of debate surround the use of intraoperative cholangiography (IOC) during cholecystectomy. To the present day, the role of IOC is controversial as regards decreasing the rate of bile duct injury (BDI). We aimed to review and analyse the available literature on the benefits of IOC during cholecystectomy. METHODS A systematic literature search was performed until 19 October 2020 in five databases using the following search keys: cholangiogra* and cholecystectomy. The primary outcomes were BDI and retained stone rate. To investigate the differences between the groups (routine IOC vs selective IOC and IOC vs no IOC), we calculated weighted mean differences (WMD) for continuous outcomes and relative risks (RR) for dichotomous outcomes, with 95% confidence intervals (CI). RESULTS Of the 19,863 articles, 38 were selected and 32 were included in the quantitative synthesis. Routine IOC showed no superiority compared to selective IOC in decreasing BDI (RR = 0.91, 95% CI 0.66; 1.24). Comparing IOC and no IOC, no statistically significant differences were found in the case of BDI, retained stone rate, readmission rate, and length of hospital stay. We found an increased risk of conversion rate to open surgery in the no IOC group (RR = 0.64, CI 0.51; 0.78). The operation time was significantly longer in the IOC group compared to the no IOC group (WMD = 11.25 min, 95% CI 6.57; 15.93). CONCLUSION Our findings suggest that IOC may not be indicated in every case, however, the evidence is very uncertain. Further good quality research is required to address this question.
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Affiliation(s)
- Norbert Kovács
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Dávid Németh
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- Institute of Bioanalysis, University of Pécs Medical School, Pécs, Hungary
| | - Mária Földi
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Bernadette Nagy
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Stefania Bunduc
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- Gastroenterology, Hepatology and Liver Transplant Department, Fundeni Clinical Institute, Bucharest, Romania
- Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs Medical School, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Bajor
- Division of Gastroenterology, First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Katalin Eszter Müller
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs Medical School, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szabolcs Ábrahám
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Centre, University of Szeged, Semmelweis u. 8, 6720, Szeged, Hungary.
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12
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Chang H, Bates DDB, Gupta A, LeBedis CA. Use of MR in Pancreaticobiliary Emergencies. Magn Reson Imaging Clin N Am 2022; 30:479-499. [PMID: 35995475 DOI: 10.1016/j.mric.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents the MR protocols, imaging features, diagnostic criteria, and complications of commonly encountered emergencies in pancreaticobiliary imaging, which include pancreatic trauma, bile leak, acute cholecystitis, biliary obstruction, and pancreatitis. Various classifications and complications that can arise with these conditions, as well as artifacts that may mimic pathology, are also included. Finally, the emerging utility of abbreviated MR protocols is discussed.
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Affiliation(s)
- Hailey Chang
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA.
| | - David D B Bates
- Department of Radiology, Cornell University, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Avneesh Gupta
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
| | - Christina A LeBedis
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
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Rodríguez-Luna MR, Okamoto N, Al-Taher M, Keller DS, Cinelli L, Hoskere Ashoka A, Klymchenko AS, Marescaux J, Diana M. In Vivo Imaging Evaluation of Fluorescence Intensity at Tail Emission of Near-Infrared-I (NIR-I) Fluorophores in a Porcine Model. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081123. [PMID: 35892925 PMCID: PMC9332805 DOI: 10.3390/life12081123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
Over the last decade fluorescence-guided surgery has been primarily focused on the NIR-I window. However, the NIR-I window has constraints, such as limited penetration and scattering. Consequently, exploring the performance of NIR-I dyes at longer wavelengths (i.e., the NIR-II window) is crucial to expanding its application. Two fluorophores were used in three pigs to identify the mean fluorescence intensity (MFI) using two commercially available NIR-I and NIR-II cameras. The near-infrared coating of equipment (NICE) was used to identify endoluminal surgical catheters and indocyanine green (ICG) for common bile duct (CBD) characterization. The NIR-II window evaluation showed an MFI of 0.4 arbitrary units (a.u.) ± 0.106 a.u. in small bowel NICE-coated catheters and an MFI of 0.09 a.u. ± 0.039 a.u. in gastric ones. In CBD characterization, the ICG MFI was 0.12 a.u. ± 0.027 a.u., 0.18 a.u. ± 0.100 a.u., and 0.22 a.u. ± 0.041 a.u. at 5, 35, and 65 min, respectively. This in vivo imaging evaluation of NIR-I dyes confirms its application in the NIR-II domain. To the best of our knowledge, this is the first study assessing the MIF of NICE in the NIR-II window using a commercially available system. Further comparative trials are necessary to determine the superiority of NIR-II imaging systems.
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Affiliation(s)
- María Rita Rodríguez-Luna
- Research Institute against Digestive Cancer (IRCAD), 1 Place de l’Hôpital, 67000 Strasbourg, France; (N.O.); (M.A.-T.); (J.M.); (M.D.)
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
- Correspondence:
| | - Nariaki Okamoto
- Research Institute against Digestive Cancer (IRCAD), 1 Place de l’Hôpital, 67000 Strasbourg, France; (N.O.); (M.A.-T.); (J.M.); (M.D.)
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Mahdi Al-Taher
- Research Institute against Digestive Cancer (IRCAD), 1 Place de l’Hôpital, 67000 Strasbourg, France; (N.O.); (M.A.-T.); (J.M.); (M.D.)
- Maastricht University Medical Center, 6229 Maastricht, The Netherlands
| | - Deborah S. Keller
- Marks Colorectal Surgical Associates, Lankenau Medical Center, Main Line Health, Wynnewood, PA 19096, USA;
| | - Lorenzo Cinelli
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, 20132 Milan, Italy;
| | - Anila Hoskere Ashoka
- Laboratoire de Bioimagerie et Pathologies, UMR 7021 CNRS, Université de Strasbourg, 74 Route du Rhin, 67401 Illkirch, France; (A.H.A.); (A.S.K.)
| | - Andrey S. Klymchenko
- Laboratoire de Bioimagerie et Pathologies, UMR 7021 CNRS, Université de Strasbourg, 74 Route du Rhin, 67401 Illkirch, France; (A.H.A.); (A.S.K.)
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), 1 Place de l’Hôpital, 67000 Strasbourg, France; (N.O.); (M.A.-T.); (J.M.); (M.D.)
| | - Michele Diana
- Research Institute against Digestive Cancer (IRCAD), 1 Place de l’Hôpital, 67000 Strasbourg, France; (N.O.); (M.A.-T.); (J.M.); (M.D.)
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
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14
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Jackson HT, Hung CMS, Potarazu D, Habboosh N, DeAngelis EJ, Amdur RL, Estroff JM, Quintana MT, Lin P, Vaziri K, Lee J. Attending guidance advised: educational quality of surgical videos on YouTube. Surg Endosc 2022; 36:4189-4198. [PMID: 34668066 DOI: 10.1007/s00464-021-08751-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION YouTube is the most used platform for case preparation by surgical trainees. Despite its popular use, studies have noted limitations in surgical technique, safety, and vetting of these videos. This study identified the most viewed laparoscopic cholecystectomy (LC) videos on YouTube and analyzed the ability of attendings, residents, and medical students to identify critical portions of the procedure, technique, and limitations of the videos. METHODS An incognito search was conducted on YouTube using the term "laparoscopic cholecystectomy." Results were screened for length, publication date, and language. The top ten most viewed videos were presented to general surgery attendings, residents, and medical students at a single academic institution. Established rubrics were used for evaluation, including the Critical View of Safety (CVS) for LC, a modified Global Operative Assessment of Laparoscopic Skills (GOALS) score, a task-specific checklist, and visual analog scales for case difficulty and operator competence. Educational quality and likelihood of video recommendation for case preparation were evaluated using a Likert scale. Attending assessments were considered the gold standard. RESULTS Six attending surgeons achieved excellent internal consistency on CVS, educational quality, and likelihood of recommendation scales, with Cronbach alpha (⍺) of 0.93, 0.92, and 0.92, respectively. ⍺ was ≥ 0.7 in all the other scales measured. Attending evaluations revealed that only one of the ten videos attained all three established CVS criteria. Four videos demonstrated none of the CVS criteria. The mean educational quality (mEQ) was 4.63 on a 10-point scale. The mean likelihood of recommendation (mLoR) for case preparation was 2.3 on a 5-point scale. Senior resident assessments (Postgraduate Year (PGY)4 + , n = 12) aligned with attending surgeons, with no statistically significant differences in CVS attainment, mEQ, and mLoR. Junior residents (PGY1-3, n = 17) and medical students (MS3-4, n = 20) exhibited significant difference with attendings in CVS attainment, mEQ, and mLoR for more than half the videos. Both groups tended to overrate videos compared to attendings. CONCLUSION YouTube is the most popular unvetted resource used for case presentation by surgical trainees. Attending evaluations revealed that the most viewed LC videos on YouTube did not attain the CVS, and were deemed as inappropriate for case preparation, with low educational value. Senior resident video assessments closely aligned with attendings, while junior trainees were more likely to overstate video quality and value. Attending guidance and direction of trainees to high-quality, vetted resources for surgical case preparation is needed. This may also suggest a need for surgical societies with platforms for video sharing to prioritize the creation and dissemination of high-quality videos on easily accessible public platforms.
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Affiliation(s)
- Hope T Jackson
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 6B-402, Washington, DC, 20037, USA.
| | - Chen-Min S Hung
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 6B-402, Washington, DC, 20037, USA
| | - Deepika Potarazu
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 6B-402, Washington, DC, 20037, USA
| | - Noor Habboosh
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 6B-402, Washington, DC, 20037, USA
| | - Erik J DeAngelis
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 6B-402, Washington, DC, 20037, USA
| | - Richard L Amdur
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 6B-402, Washington, DC, 20037, USA
| | - Jordan M Estroff
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 6B-402, Washington, DC, 20037, USA
| | - Megan T Quintana
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 6B-402, Washington, DC, 20037, USA
| | - Paul Lin
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 6B-402, Washington, DC, 20037, USA
| | - Khashayar Vaziri
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 6B-402, Washington, DC, 20037, USA
| | - Juliet Lee
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Suite 6B-402, Washington, DC, 20037, USA
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15
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Laparoscopic Ultrasound for Bile Duct Imaging during Cholecystectomy: Clinical Impact in 785 Consecutive Cases. J Am Coll Surg 2022; 234:849-860. [DOI: 10.1097/xcs.0000000000000111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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16
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Madhok B, Nanayakkara K, Mahawar K. Safety considerations in laparoscopic surgery: A narrative review. World J Gastrointest Endosc 2022; 14:1-16. [PMID: 35116095 PMCID: PMC8788169 DOI: 10.4253/wjge.v14.i1.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/11/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery has many advantages over open surgery. At the same time, it is not without its risks. In this review, we discuss steps that could enhance the safety of laparoscopic surgery. Some of the important safety considerations are ruling out pregnancy in women of the childbearing age group; advanced discussion with the patient regarding unexpected intraoperative situations, and ensuring appropriate equipment is available. Important perioperative safety considerations include thromboprophylaxis; antibiotic prophylaxis; patient allergies; proper positioning of the patient, stack, and monitor(s); patient appropriate pneumoperitoneum; ergonomic port placement; use of lowest possible intra-abdominal pressure; use of additional five-millimetre (mm) ports as needed; safe use of energy devices and laparoscopic staplers; low threshold for a second opinion; backing out if unsafe to proceed; avoiding hand-over in the middle of the procedure; ensuring all planned procedures have been performed; inclusion of laparoscopic retrieval bags and specimens in the operating count; avoiding 10-15 mm ports for placement of drains; appropriate port closures; and use of long-acting local anaesthetic agents for analgesia. Important postoperative considerations include adequate analgesia; early ambulation; careful attention to early warning scores; and appropriate discharge advice.
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Affiliation(s)
- Brij Madhok
- Upper GI Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
| | - Kushan Nanayakkara
- Upper GI Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
| | - Kamal Mahawar
- Department of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, United Kingdom
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17
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Ali SW, Kazmi S, Jabeen A, Ashraf MS, Mateen Khan MA. Choledochal cyst associated with anomalous biliary drainage. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Song Y, Qin G, Du L, Hu H, Han Y. In vitro and in vivo assessment of biocompatibility of AZ31 alloy as biliary stents: a preclinical approach. Arch Med Sci 2022; 18:195-205. [PMID: 35154540 PMCID: PMC8826861 DOI: 10.5114/aoms.2020.92675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/15/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Biomaterial technology due to its lack of or minimal side effects in tissues has great potential. Traditionally biomaterials used were cobalt-chromium, stainless steel and nitinol alloys. Biomaterials such as magnesium (Mg) and zinc (Zn) have good biocompatibility and consequently can be a potential material for medical implants. To date, the effects of AZ31 alloy stent on cell apoptosis are still unclear. The current investigation was designed to determine the effect of AZ31 alloy stent on necrosis and apoptosis of common bile duct (CBD) epithelial cells. MATERIAL AND METHODS We experimented with application of different concentrations of AZ31 alloy stent to primary mouse extrahepatic bile epithelial cells (MEBECs) and estimated the effect on apoptosis and necrotic cells. Apoptosis and pro-apoptosis expression were estimated through real-time PCR. For in vivo protocol, we used rabbits, implanted the AZ31 bile stent, and estimated its effect on the CBD. AZ31 (40%) concentration showed an effect on the apoptotic and necrotic cells. RESULTS Real-time PCR revealed that AZ31 (40%) concentration increased the apoptotic genes such as NF-κB, caspase-3, Bax and Bax/Bcl-2 ratio as compared to the control group. In the in vivo experiment, AZ31 alloy stents were implanted into the CBD and showed an effect on the alteration the hematological, hepatic and non-hepatic parameters. CONCLUSIONS To conclude, it can be stated that AZ31 induces apoptosis via alteration in genes including nuclear factor kappa-B (NF-κB), caspase-3, Bax and Bax/Bcl-2 ratio and improved the hematological, hepatic and non-hepatic parameters.
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Affiliation(s)
- Yong Song
- Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Gaoping Qin
- Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Lixue Du
- Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Haitian Hu
- Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Yong Han
- Material Science and Engineering, Xi’an Jiaotong University, Beilin District, Xi’an, Shaanxi, China
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Wang P, Fang C, Lin HM, Li XJ, Luo D, Gan Y, Yang XL, Tian J, Li B, Su S. Detection of the common bile duct in difficult bile duct exploration using indocyanine green fluorescence imaging: A case report. Photodiagnosis Photodyn Ther 2021; 36:102610. [PMID: 34728421 DOI: 10.1016/j.pdpdt.2021.102610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/06/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
We describe two cases using indocyanine green (ICG) fluorescence imaging for visualization of the common bile duct (CBD) in patients with difficult Bile duct exploration (BDE) due to extensive dense adhesions around the hepatoduodenal ligament. The CBD was rapidly detected under fluorescence guidance without excessive dissection of extensive dense adhesions. It is illustrated that the use of ICG fluorescence imaging is effective and feasible for detecting the CBD and thus we highly recommend this method during difficult BDE.
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Affiliation(s)
- Piao Wang
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Luzhou 646000, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou 646000, China.
| | - Cheng Fang
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Luzhou 646000, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou 646000, China.
| | - Hao-Min Lin
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Luzhou 646000, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou 646000, China.
| | - Xu-Jia Li
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Luzhou 646000, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou 646000, China.
| | - De Luo
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Luzhou 646000, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou 646000, China.
| | - Yu Gan
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Luzhou 646000, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou 646000, China.
| | - Xiao-Li Yang
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Luzhou 646000, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou 646000, China.
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
| | - Bo Li
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Luzhou 646000, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou 646000, China.
| | - Song Su
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Luzhou 646000, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou 646000, China.
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20
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Cho YJ, Nam SH, Oh E, Luciano MP, Lee C, Shin IH, Schnermann MJ, Cha J, Kim KW. Laparoscopic cholecystectomy in a swine model using a novel near-infrared fluorescent IV dye (BL-760). Lasers Surg Med 2021; 54:305-310. [PMID: 34490931 DOI: 10.1002/lsm.23470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Bile duct injury during laparoscopic cholecystectomy has an incidence rate of 1%-2% and commonly appears under conditions of severe inflammation, adhesion, or unexpected anatomical variations. Despite the difficulties and rising concerns of identifying bile duct during surgeries, surgeons do not have a specific modality to identify bile duct except intraoperative cholangiography. While no biliary-specific fluorescent dye exists for clinical use, our team has previously described the development of a preclinical biliary-specific dye, BL-760. Here, we present our study of laparoscopic cholecystectomy using the fluorescent dye in a swine model. STUDY DESIGN/MATERIALS AND METHODS With an approval from Institutional Animal Care and Use Committee, two 20-25 kg swine underwent laparoscopic abdominal surgery using a Food and Drug Administration-cleared fluorescent laparoscopic system. Images of the liver and gallbladder were taken both before and after intravenous injection of the novel fluorescent dye. The dye was dosed at 60 μg/kg and injected via the ear vein. The amount of time taken to visualize fluorescence in the biliary tract was measured. Fluorescent signal was observed after injection, and target-to-background ratio (TBR) of the biliary tract to surrounding cystic artery and liver parenchyma was measured. RESULTS Biliary tract visualization under fluorescent laparoscopy was achieved within 5 min after the dye injection without any adverse effects. Cystic duct and extrahepatic duct were clearly visualized and identified with TBR values of 2.19 and 2.32, respectively, whereas no fluorescent signal was detected in liver. Cystic duct and artery were successfully ligated by an endoscopic clip applier with the visual assistance of highlighted biliary tract images. Laparoscopic cholecystectomy was completed within 30 min in each case without any complications. CONCLUSIONS BL-760 is a novel preclinical fluorescent dye useful for intraoperative identification and visualization of biliary tract. Such fluorescent dye that is exclusively metabolized by liver and rapidly excreted into biliary tract would be beneficial for all types of hepato-biliary surgeries. With the validation of additional preclinical data, this novel dye has potential to be a valuable tool to prevent any iatrogenic biliary injuries and/or bile leaks during laparoscopic abdominal and liver surgeries.
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Affiliation(s)
- Yu Jeong Cho
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA.,Department of Surgery, Asan Medical Center, Songpa-Gu, Seoul, South Korea
| | - So-Hyun Nam
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA.,Department of Surgery, Dong-A University College of Medicine, Seo-Gu, Busan, South Korea
| | - Eugene Oh
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA.,Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael P Luciano
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
| | - Choonghee Lee
- InTheSmart Co., Center for Medical Innovation Bld., Jongro-gu, Seoul, South Korea
| | - Il Hyung Shin
- InTheSmart Co., Center for Medical Innovation Bld., Jongro-gu, Seoul, South Korea
| | - Martin J Schnermann
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
| | - Jaepyeong Cha
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kwan Woo Kim
- Department of Surgery, Dong-A University College of Medicine, Seo-Gu, Busan, South Korea
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Chu BK, Gnyawali B, Cloyd JM, Hart PA, Papachristou GI, Lara LF, Groce JR, Hinton A, Conwell DL, Krishna SG. Early unplanned readmissions following same-admission cholecystectomy for acute biliary pancreatitis. Surg Endosc 2021; 36:3001-3010. [PMID: 34159465 DOI: 10.1007/s00464-021-08595-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/06/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Same-admission cholecystectomy (CCY) is recommended for mild acute biliary pancreatitis (biliary-AP). However, there is a paucity of research investigating reasons for early (30-day) unplanned readmissions in patients who undergo CCY for biliary-AP. Hence, we sought to investigate this gap using a large population database. METHODS Using the Nationwide Readmission Database (2010-2014), we identified all adults (age ≥ 18 years) with a principal diagnosis of biliary-AP who had undergone CCY during the index hospitalization. Multivariable logistic regression models were obtained to assess independent predictors for 30-day readmission. Principal diagnosis for all readmissions was collected to ascertain the indications for early readmission. RESULTS During the study period, 118,224 patients underwent same-admission CCY for biliary-AP. Three-fourths of all patients underwent invasive cholangiography during the hospitalization (intraoperative cholangiogram (IOC) = 57,038, ERCP = 31,500). The rate of early (30-day) readmission was 7.25% (n = 8574). Exacerbation of prior medical conditions (42.2%), sequelae of biliary-AP (resolving and recurrent pancreatitis, pseudocysts) (27.6%), surgical site and other postoperative complications (16%), choledocholithiasis and/or bile leak (9.6%), and preventable hospital-acquired conditions (4.6%) accounted for early readmissions. On multivariable analysis, predictors for readmission included male sex (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08-1.28), insurance type (Medicare insurance [OR 1.26, 95% CI 1.13-1.40]; Medicaid [OR 1.22, 95% CI 1.09-1.38]), outside-facility discharge (OR 1.35, 95% CI 1.16-1.57), severe AP (OR 1.35, 95% CI 1.21-1.50), and ≥ 3 Elixhauser comorbidities (OR 1.55, 95% CI 1.41-1.69). Performance of IOC (OR 0.90, 95% CI 0.82-0.97) and ERCP (OR 0.81, 95% CI 0.73-0.89) were associated with decreased risk of early readmission. CONCLUSION In this study, using a national population database evaluating patients who underwent same-admission CCY after biliary-AP, we identified potentially modifiable risk factors and causes for early readmission as well as opportunities to improve clinical care.
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Affiliation(s)
- Brandon K Chu
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Bipul Gnyawali
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, James Cancer Center and Solove Research Institute, Columbus, OH, USA
| | - Phil A Hart
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Georgios I Papachristou
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Luis F Lara
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Jeffrey R Groce
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Darwin L Conwell
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Somashekar G Krishna
- Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA.
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GELDIGITTI IT, KARAHAN SR, ADAS G, KOC B, GURBUZ E, OZSOY A. Treatment of common bile duct stones following failed endoscopic retrograde cholangiopancreatography. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wu D, Liu S, Zhou J, Chen R, Wang Y, Feng Z, Lin H, Qian J, Tang BZ, Cai X. Organic Dots with Large π-Conjugated Planar for Cholangiography beyond 1500 nm in Rabbits: A Non-Radioactive Strategy. ACS NANO 2021; 15:5011-5022. [PMID: 33706510 DOI: 10.1021/acsnano.0c09981] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Iatrogenic extrahepatic bile duct injury remains a dreaded complication while performing cholecystectomy. Although X-ray based cholangiography could reduce the incidence of biliary tract injuries, the deficiencies including radiation damage and expertise dependence hamper its further clinical application. The effective strategy for intraoperative cholangiography is still urgently required. Herein, a fluorescence-based imaging approach for cholangiography in the near-infrared IIb window (1500-1700 nm) using TT3-oCB, a bright aggregation-induced emission luminogen with large π-conjugated planar unit, is reported. In phantom studies, TT3-oCB nanoparticles exhibit high near-infrared IIb emission and show better image clarity at varying penetrating depths. When intrabiliary injected into the gallbladder or the common bile duct of the rabbit, TT3-oCB nanoparticles enable the real-time imaging of the biliary structure with deep penetrating capability and high signal-to-background ratio. Moreover, the tiny iatrogenic biliary injuries and the gallstones in established disease models could be precisely diagnosed by TT3-oCB nanoparticle assisted near-infrared IIb imaging. In summary, we reported a feasible application for aggregation-induced emission dots as biliary contrast agent and realized high-quality cholangiography in the near-infrared IIb window with precise diagnostic ability and nonradioactive damage, which could possibly be applied for intraoperative diagnosis.
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Affiliation(s)
- Di Wu
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Shunjie Liu
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science and State Key Laboratory of Molecular Neuroscience, and Division of Biomedical Engineering, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
| | - Jing Zhou
- State Key Laboratory of Modern Optical Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, International Research Center for Advanced Photonics, Zhejiang University, Hangzhou 310058, China
| | - Runze Chen
- State Key Laboratory of Modern Optical Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, International Research Center for Advanced Photonics, Zhejiang University, Hangzhou 310058, China
| | - Yifan Wang
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Zhe Feng
- State Key Laboratory of Modern Optical Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, International Research Center for Advanced Photonics, Zhejiang University, Hangzhou 310058, China
| | - Hui Lin
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Jun Qian
- State Key Laboratory of Modern Optical Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, International Research Center for Advanced Photonics, Zhejiang University, Hangzhou 310058, China
| | - Ben Zhong Tang
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science and State Key Laboratory of Molecular Neuroscience, and Division of Biomedical Engineering, The Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
- Center for Aggregation-Induced Emission, SCUT-HKUST Joint Research Institute, State Key Laboratory of Luminescent Materials and Devices, South China University of Technology, Guangzhou 510640, China
- HKUST-Shenzhen Research Institute, Nanshan, Shenzhen 518057, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
- Key Laboratory of Laparoscopic Technology of Zhejiang Province; Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease; Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Zhejiang University Cancer Center, Hangzhou 310016, China
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Chavira AM, Rivas JF, Molina APRF, de la Cruz SA, Zárate AC, Musa AB, Osorio VJC. The educational quality of the critical view of safety in videos on youtube® versus specialized platforms: which is better? Critical view of safety in virtual resources. Surg Endosc 2021; 36:337-345. [PMID: 33527206 DOI: 10.1007/s00464-021-08286-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The surgical education has evolved by adopting the visual platforms as a resource of searching. The videos complement the visual learning of surgical techniques of trainees, residents, and surgeons. YouTube® is the most frequently consulted platform in the surgical field. WebSurg® and GIBLIB® are two recognized medical platforms. The Critical View of Safety (CVS) is the most important and effective method to reduce the risk of bile duct injury (BDI) in laparoscopic cholecystectomy (LC). Reaching a satisfactory CVS is a crucial point. We evaluated the CVS of videos on WebSurg® and GIBLIB®, comparing the results with those of the worldwide most popular video platform. METHODS We performed a search under the term "Laparoscopic cholecystectomy" on the virtual platforms YouTube®, GIBLIB®, and WebSurg®. Three evaluators reviewed the 77 selected videos using the "Sanford-Strasberg' CVS score." The inferential analysis was performed between two groups: YouTube® and Non-YouTube (GIBLIB® and WebSurg®). The characteristics of each video were analyzed including country of origin, type of profile, number of views, and number of Likes. RESULTS Satisfactory CVS obtained from each of the platforms was GIBLIB® 40%; WebSurg® 44.4%; YouTube® 27.7%. The comparative analysis of CVS quality and CVS score for the Non-YouTube and YouTube® groups did not show a significant difference (p = 0.142, p = 0.377, respectively). CONCLUSION The videos on GIBLIB® and WebSurg® offer a higher probability of satisfactory CVS compared to YouTube®. Nevertheless, there is no significant superiority of GIBLIB® and WebSurg® over YouTube®.
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Affiliation(s)
- Antonio Marmolejo Chavira
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico.
| | - Jorge Farell Rivas
- Department of Surgery, Director of Surgical Residency Program, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Ana Paula Ruiz Funes Molina
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Sergio Ayala de la Cruz
- Department of Clinical Pathology, Hospital Universitario "Dr. José E. González", Av. Francisco I. Madero Pte. Mitras Centro, 1st Floor, 64460, Monterrey, Nuevo Leon, Mexico
| | - Alejandro Cruz Zárate
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Alfonso Bandin Musa
- Department of Transplants, Hospital Central Sur de Alta Especialidad, PEMEX, 10th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Víctor José Cuevas Osorio
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
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Management of post-cholecystectomy bile duct injuries without operative mortality at Jakarta tertiary hospital in Indonesia - A cross-sectional study. Ann Med Surg (Lond) 2021; 62:211-215. [PMID: 33537132 PMCID: PMC7843359 DOI: 10.1016/j.amsu.2021.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/10/2021] [Indexed: 12/23/2022] Open
Abstract
Background Bile duct injuries (BDI) can occur after a cholecystectomy procedure performed by any surgeons. These ensured a poor experience for patients and surgeons and marred the minimally invasive surgery approach, which should have promised rapid recovery. This study aimed to evaluate the management of BDI following cholecystectomy procedure in Cipto Mangunkusumo Hospital, Jakarta, as a tertiary hospital. Method Descriptive retrospective cross-sectional design was used on open and laparoscopic cholecystectomy performed between January 2008 and December 2018. This study is reported in line with STROCSS 2019 Criteria. Result A total of 24 patients with BDI were included, with female preponderance (62,5%) with a median age 45 (21–58) years. Sixteen post-laparoscopy cases were classified according to Strasberg classification; 6 cases were type E3, 2 cases each of type E1 and E2, and one case each of Strasberg C and D. The remaining 4 were Strasberg A. Eight post-open cases were classified based on Bismuth criteria: 4 cases of Bismuth I, 1 case of Bismuth II, and 3 cases of Bismuth III. Five cases were presented with massive biloma, 7 with jaundice, and 10 cases with biliary-pancreatic fluid production through the surgical drain. The average time of problem recognition to patient's admission was 19 (7–152) days and admission to surgery was 14 days. Roux-en-Y hepaticojejunostomy was performed in 18 cases, choledocho-duodenostomy in 2 cases, and primary ligation cystic duct in 4 cases. Post-operative follow-up showed 2 patients had recurrent cholangitis, 2 superficial surgical site infection, and 2 relaparotomy due to bile anastomosis leakage and burst abdomen. The median length of hospital stay was 38 (14–53) days with zero hospital mortality. No stricture detected in long term follow-up. Conclusion Common bile duct was the most frequent site of BDI, and Roux-en-Y hepaticojejunostomy reconstruction performed by HPB surgeons on high volume center results in a good outcome.
The common bile duct was the most frequent site of BDI Reconstruction of Roux-en-Y hepaticojejunostomy side-to-side by HPB surgeons on high volume center results in a good outcome with zero operative mortality One third of BDI cases referred to our center occurred after open approach. This data can be used as an information for evaluation of General Surgery Training Program in order to improve learning curve thus reduce rate of iatrogenic injury in open cholecystectomy Delay of treatment and reconstruction mostly in intermediate phase (2–12 weeks after event) can be advantageous for patients with optimal preoperative support. It is essential to evaluate the surgical difficulty appropriately and standardize treatment strategies to reduce serious complications.
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Quiroz HJ, Valencia SF, Willobee BA, Ferrantella AR, Ryon EL, Thorson CM, Sola JE, Perez EA. Utility of routine intraoperative cholangiogram during cholecystectomy in children: A nationwide analysis of outcomes and readmissions. J Pediatr Surg 2021; 56:61-65. [PMID: 33158507 DOI: 10.1016/j.jpedsurg.2020.09.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE This study aims to determine postoperative outcomes and readmissions in pediatric cholecystectomy with routine intraoperative cholangiogram (IOC) utilization. METHODS The Nationwide Readmissions Database 2010-2014 was queried for all pediatric cholecystectomies. A propensity score-matched analysis (PSMA) with over 30 covariates was performed between cholecystectomy alone (CCY) versus those with routine IOC (CCY + IOC, no biliary obstruction, dilatation, or pancreatitis). χ2 analysis or Mann-Whitney U were used for statistical analysis with p < 0.05 set as significant. RESULTS 34,390 cholecystectomies were performed: 92% were laparoscopic, most were teenage females (75%, 15 years [13-17]) and did not undergo IOC (75%). Postoperative mortality rate was 0.1%. The PSMA cohort comprised of 1412 CCY and 1453 CCY + IOC. Patients with CCY alone had higher rates of 30-day (7% vs 5%), 1-year readmissions (13% vs 11%) and had higher rates of overall complications (22% vs 12%) compared with CCY + IOC, all p < 0.05. Although uncommon, bile duct injuries were more prevalent in CCY (2% vs 0%, p < 0.001), while there was no difference in readmissions for retained stones. Resource utilization was increased in CCY patients, likely due to increased complication rates. CONCLUSION This nationwide PSMA suggests pediatric CCY with routine IOC is associated with decreased readmissions, overall resource utilization, complications, and bile duct injuries. TYPE OF STUDY Retrospective Comparative Study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hallie J Quiroz
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | | | - Brent A Willobee
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Anthony R Ferrantella
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Emily L Ryon
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Chad M Thorson
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan E Sola
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo A Perez
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
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Sebastian M, Sebastian A, Rudnicki J. The evaluation of B-SAFE and ultrasonographic landmarks in safe orientation during laparoscopic cholecystectomy. Wideochir Inne Tech Maloinwazyjne 2020; 15:546-552. [PMID: 33294068 PMCID: PMC7687673 DOI: 10.5114/wiitm.2020.100972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Even though the prevalence of bile duct injury (BDI) is nowadays lower than before and close to the era of open cholecystectomy, there is a strong need to make it even lower. B-SAFE is a group of five visual landmarks that may be used before dissection in the hepatocystic triangle for better orientation around the gallbladder. Another method is laparoscopic ultrasound (LUS), which enables confirmation of structures in the hepatoduodenal ligament and delineation of the safe plane of dissection. AIM To evaluate the use of B-SAFE and ultrasonographic landmarks during laparoscopic cholecystectomy in navigation around the gallbladder. MATERIAL AND METHODS The study group consisted of 158 patients with symptomatic cholecystolithiasis. The methods of intraoperative orientation around the gallbladder attempted in every patient during laparoscopic cholecystectomy included B-SAFE and ultrasonographic landmarks. RESULTS The identification rate of ultrasonographic landmarks - the upper border of "Mickey Mouse" sign (MMS) (the equivalent of the Rouviere's sulcus), the bile duct, and the hepatic artery - was significantly higher in patients with body mass index ≥ 30 kg/m2 and fibrosis and chronic inflammation in the gallbladder neck than B-SAFE. LUS was also significantly more successful in the identification of the bile duct in the whole study group than B-SAFE. There were no significant differences according to the identification of the duodenum. The conversion rate was 2.6%, and we did not observe any BDI. CONCLUSIONS Visual landmarks defined in B-SAFE are not as reliable as ultrasonographic landmarks; thus, LUS should be taken into consideration in the first place as a method of navigation around the gallbladder.
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Affiliation(s)
- Maciej Sebastian
- Department of General, Minimally Invasive, and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Rudnicki
- Department of General, Minimally Invasive, and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
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Fluorescent cholangiography significantly improves patient outcomes for laparoscopic cholecystectomy. Surg Endosc 2020; 35:5729-5739. [PMID: 33052527 DOI: 10.1007/s00464-020-08045-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the most common elective abdominal surgery in the USA, with over 750,000 performed annually. Fluorescent cholangiography (FC) using indocyanine green dye (ICG) permits identification of extrahepatic biliary structures to facilitate dissection without requiring cystic duct cannulation. Achieving the "critical view of safety" with assistance of ICG cholangiogram may support identification of anatomy, safely reduce conversion to open procedures, and decrease operative time. We assess the utility of FC with respect to anatomic visualization during LC and its effects on patient outcomes. METHODS A retrospective review of a prospectively maintained database identified patients undergoing laparoscopic cholecystectomy at a single academic center from 2013 to 2019. Exclusion criteria were primary open and single incision cholecystectomy. Patient factors included age, sex, BMI, and Charlson Comorbidity Index. Outcomes included operative time, conversion to open procedure, length of stay (LOS), mortality rate, and 30-day complications. A multivariable logistic regression was performed to determine independent predictors for open conversion. RESULTS A total of 1389 patients underwent laparoscopic cholecystectomy. 69.8% were female; mean age 48.6 years (range 15-94), average BMI 29.4 kg/m2 (13.3-55.6). 989 patients (71.2%) underwent LC without fluorescence and 400 (28.8%) underwent FC with ICG. 30-day mortality detected 2 cases in the non-ICG group and zero with ICG. ICG reduced operative time by 26.47 min per case (p < 0.0001). For patients with BMI ≥ 30 kg/m2, operative duration for ICG vs non-ICG groups was 75.57 vs 104.9 min respectively (p < 0.0001). ICG required conversion to open at a rate of 1.5%, while non-ICG converted at a rate of 8.5% (p < 0.0001). Conversion rate remained significant with multivariable analysis (OR 0.212, p = 0.001). A total of 19 cases were aborted (1.35%), 8 in the ICG group (1.96%) and 11 in the non-ICG group (1.10%), these cases were not included in LC totals. Average LOS was 0.69 vs 1.54 days in the ICG compared to non-ICG LCs (p < 0.0001), respectively. Injuries were more common in the non-ICG group, with 9 patients sustaining Strasberg class A injuries in the non-ICG group and 2 in the ICG group. 1 CBDI occurred in the non-ICG group. There was no significant difference in 30-day complication rates between groups. CONCLUSION ICG cholangiography is a non-invasive adjunct to laparoscopic cholecystectomy, leading to improved patient outcomes with respect to operative times, decreased conversion to open procedures, and shorter length of hospitalization. Fluorescence cholangiography improves visualization of biliary anatomy, thereby decreasing rate of CBDI, Strasberg A injuries, and mortality. These findings support ICG as standard of care during laparoscopic cholecystectomy.
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The “critical view of safety (CVS)” cannot be applied—What to do? Strategies to avoid bile duct injuries. Eur Surg 2020. [DOI: 10.1007/s10353-020-00660-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
SummaryLaparoscopic cholecystectomy has become the standard procedure worldwide since the early 1990s for those patients whose gallbladder has to be removed as part of their underlying disease (NIH Consensus Statement 1992). The most common complication is iatrogenic bile duct injury, which has not improved significantly since the introduction of open laparoscopic cholecystectomy as compared with open cholecystectomy. The intraoperative injuries are mostly the result of a misinterpretation of anatomical structures due to severe inflammation or topographical variations. In order to minimize this risk, a number of improved operative techniques and behavioral measures have been formulated. Here, we present methodological and operative possibilities as well as techniques that in unclear situations can help to minimize the risk of intraoperative injuries of the biliary tract and the accompanying vascular system.
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Namikawa T, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Nakayama T, Inoue K, Sato T, Kobayashi M, Hanazaki K. Evolution of photodynamic medicine based on fluorescence image-guided diagnosis using indocyanine green and 5-aminolevulinic acid. Surg Today 2020; 50:821-831. [PMID: 31346808 DOI: 10.1007/s00595-019-01851-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/21/2019] [Indexed: 02/05/2023]
Abstract
New diagnostic techniques based on photodynamic medicine, such as near-infrared fluorescence using indocyanine green (NIR-ICG) and 5-aminolevulinic acid-mediated photodynamic diagnosis (ALA-PDD), are aiding navigation tasks across various fields of surgery. Specifically, NIR-ICG is being used for the intraoperative identification of sentinel lymph nodes or blood vessels in organ resection and for blood flow evaluation in surgery. These ICG-fluorescent imaging techniques could provide an additional and potentially valuable way to identify vascular and lymphatic structures in surrounding tissue. 5-Aminolevulinic acid is a precursor of a photosensitizing substance with affinity for tumors; thus, diagnostic laparoscopy using ALA-PDD in combination should improve the accuracy of detecting peritoneal dissemination in patients with advanced gastric cancer. The ability to overlay fluorescent imaging with conventional color images in real time using ALA-PDD and NIR with ICG would be of immense benefit to surgeons, providing good visualization and detection of target lesions not seen with the naked eye. A multi-center clinical study examining the safety and efficacy of ALA-PDD during laparoscopic examination for patients with advanced gastric cancer is currently underway in the form of doctor-initiated trials, and further verification studies will be conducted. Such imaging capability could have broad potential across cancer and vascular surgery.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan.
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan.
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Taku Nakayama
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
- Department of Urology, Kochi Medical School, Kochi, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
- Department of Cardiovascular Control, Kochi Medical School, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
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Recommendation for cholecystectomy protocol based on intraoperative ultrasound - a single-centre retrospective case-control study. Wideochir Inne Tech Maloinwazyjne 2020; 16:54-61. [PMID: 33786117 PMCID: PMC7991927 DOI: 10.5114/wiitm.2020.93999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/24/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction There is a strong need to make laparoscopic cholecystectomy as safe as possible, but sometimes complications in the form of bile duct and/or vascular injury occur. The safe plane of dissection can be precisely identified with intraoperative ultrasound, ensuring reduction of the complication rate to a minimum. Aim To evaluate the advantages of the cholecystectomy protocol based on the use of intraoperative ultrasound during laparoscopic and open cholecystectomy. Material and methods The study group consisted of 700 patients with symptomatic cholecystolithiasis, which was divided into two subgroups: with the critical view of safety only (312 patients) and with the critical view of safety + laparoscopic/open cholecystectomy ultrasound (388 patients). Laparoscopic cholecystectomy and conversion in patients from the second subgroup were performed under the control of intraoperative ultrasound. Results We did not observe any biliary complications, and the visualization of the common bile duct, the proper hepatic artery and the portal vein was obtained in every patient from the critical view of safety + laparoscopic/open cholecystectomy ultrasound group. The mean time of the operation was significantly shorter and the conversion, biliary injury and intraoperative bleeding rates were significantly lower in this group of patients. Conclusions Intraoperative ultrasound is a very efficient and safe method of guidance, and its use should be standard along with the critical view of safety during cholecystectomy.
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Lehrskov LL, Westen M, Larsen SS, Jensen AB, Kristensen BB, Bisgaard T. Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial. Br J Surg 2020; 107:655-661. [PMID: 32057103 DOI: 10.1002/bjs.11510] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/25/2019] [Accepted: 12/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Safe laparoscopic cholecystectomy may necessitate biliary imaging, and non-invasive fluorescence cholangiography may have advantages over contrast X-ray cholangiography. This trial compared fluorescence and X-ray cholangiography for visualization of the critical junction between the cystic, common hepatic and common bile ducts. METHODS This non-inferiority blinded RCT included patients who had either intraoperative fluorescence cholangiography using 0·05 mg/kg indocyanine green or X-ray cholangiography during elective laparoscopic cholecystectomy. RESULTS Between March 2015 and August 2018, a total of 120 patients were randomized (60 in each group). There were no drop-outs and 30-day follow-up data were available for all patients. In intention-to-treat analysis, there was no difference between the fluorescence and X-ray cholangiography groups in ability to visualize the critical junction (49 of 60 versus 51 of 60 respectively; P = 0·230). Fluorescence cholangiography was faster by a few minutes: median 2·0 (range 0·5-5·0) versus 4·8 (1·3-17·6) min (P < 0·001). CONCLUSION Fluorescence cholangiography was confirmed to be non-inferior to X-ray cholangiography in visualizing the critical junction during laparoscopic cholecystectomy. Registration number: NCT02344654 ( http://www.clinicaltrials.gov).
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Affiliation(s)
- L L Lehrskov
- Gastrounit, Surgical Section, Centre for Surgical Research, Hvidovre Hospital, University of Copenhagen, Køge, Denmark
| | - M Westen
- Gastrounit, Surgical Section, Køge, Denmark
| | - S S Larsen
- Gastrounit, Surgical Section, Køge, Denmark
| | | | - B B Kristensen
- Ambulatory Surgery Department, Hvidovre Hospital, Hvidovre, Denmark
| | - T Bisgaard
- Surgical Department, Zealand University Hospital, Køge, Denmark
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Affiliation(s)
- Maria S Altieri
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 Euclid Avenue, Campus Box 8109, St Louis, MO 63110, USA
| | - L Michael Brunt
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 Euclid Avenue, Campus Box 8109, St Louis, MO 63110, USA.
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Bove A, Panaccio P, di Renzo R, Palone G, Ricciardiello M, Ciuffreda S, Bongarzoni G. How to choose the most appropriate technique for the single-stage treatment of cholecysto-choledocolithiasis? Gastroenterol Rep (Oxf) 2019; 7:258-262. [PMID: 31413832 PMCID: PMC6688737 DOI: 10.1093/gastro/goz022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/24/2019] [Accepted: 03/01/2019] [Indexed: 11/25/2022] Open
Abstract
Background We utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of cholecysto-choledocolithiasis. The goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical procedure. Methods A total of 180 patients affected by calculi of the gallbladder and bile duct underwent the single-stage treatment. According to several pre-operative parameters, 141 patients had to supposedly undergo transcystic clearance of the bile duct, while 39 patients had to be treated with the rendezvous technique. All patients were treated with the sequential procedure: first, we tried the transcystic procedure and, if there was a failure, we used a rendezvous technique. We prospectively analysed each group based on a series of variables such as sex, age, operative time, success rate of proposed treatment, conversion rate, post-operative complications and hospital stay. Results Transcystic clearance was successful in 134 out of 141 patients (95.0%), while 2 patients needed to undergo a laparo-endoscopy procedure (failure). Thirty-five out of 39 patients (89.7%) obtained common bile-duct (CBD) clearance through the rendezvous technique, while 1 patient obtained clean-up through the simple transcystic procedure (failure). Five out of 141 patients with transcystic clearance and 3 out of 39 patients with the rendezvous technique underwent laparotomy CBD clearance with conversion rates of 3.5% and 7.7%, respectively. Post-operative complications showed similar percentages for both procedures. However, the surgical time turned out to be longer for the rendezvous technique. Conclusions The one-stage procedure for the treatment of cholecysto-choledocolithiasis was possible in 94% of the cases utilizing a surgical technique selected according to the patient’s case history. The pre-operative parameters, such as jaundice, CBD diameters and stone diameters, have certified their reliability as good predictors of the most suitable procedure to follow.
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Affiliation(s)
- Aldo Bove
- Department of Medicine, Dentistry and Biotechnology, University 'G. D'Annunzio', Via dei Vestini, Chieti, Italy
| | - Paolo Panaccio
- Department of Medicine, Dentistry and Biotechnology, University 'G. D'Annunzio', Via dei Vestini, Chieti, Italy
| | - Raffaella di Renzo
- Department of Medicine, Dentistry and Biotechnology, University 'G. D'Annunzio', Via dei Vestini, Chieti, Italy
| | - Gino Palone
- Department of Medicine, Dentistry and Biotechnology, University 'G. D'Annunzio', Via dei Vestini, Chieti, Italy
| | - Marco Ricciardiello
- Department of Medicine, Dentistry and Biotechnology, University 'G. D'Annunzio', Via dei Vestini, Chieti, Italy
| | - Sara Ciuffreda
- Department of Medicine, Dentistry and Biotechnology, University 'G. D'Annunzio', Via dei Vestini, Chieti, Italy
| | - Giuseppe Bongarzoni
- Department of Medicine, Dentistry and Biotechnology, University 'G. D'Annunzio', Via dei Vestini, Chieti, Italy
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van Manen L, Tummers QRJG, Inderson A, Bhalla A, Vahrmeijer AL, Bonsing BA, Mieog JSD. Intraoperative detection of the remnant cystic duct during robot-assisted surgery using near-infrared fluorescence imaging: a case report. BMC Surg 2019; 19:104. [PMID: 31391103 PMCID: PMC6686477 DOI: 10.1186/s12893-019-0567-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/23/2019] [Indexed: 12/17/2022] Open
Abstract
Background Post cholecystectomy syndrome is characterized as recurrence of symptoms as experienced before cholecystectomy. In rare cases, a remnant cystic duct is causing these symptoms and occasionally surgical resection is performed. During surgery, visualization of the biliary ducts could be difficult due to inflammation and dense adhesions. Case presentation In this article, we presented a 36-year old woman with post-cholecystectomy syndrome in which we evaluated the feasibility of near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) for visualization of the remnant cystic and common bile duct during robot-assisted surgery. Intraoperative visualization of the remnant biliary duct and other important structures was feasible, and resection of the remnant cystic duct was successfully performed under fluorescence guidance, without any complications. Conclusions NIR fluorescence imaging of the biliary ducts using ICG does not prolong the operating time, and could potentially decrease the operation time in difficult procedures, because of easy and fast detection of the biliary tract. Furthermore, it is a non-hazardous and non-invasive technique, as it does not require use of radiation and cannot cause bile duct injury. This case illustrated that ICG NIR fluorescence imaging during difficult robot-assisted surgical procedures of the bile ducts is effective and therefore highly recommended. Electronic supplementary material The online version of this article (10.1186/s12893-019-0567-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Labrinus van Manen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Quirijn R J G Tummers
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Akin Inderson
- Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands
| | - Abha Bhalla
- Department of Gastroenterology, Haga Hospital, The Hague, The Netherlands
| | - Alexander L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
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Ten-year Audit of Safe Bail-Out Alternatives to the Critical View of Safety in Laparoscopic Cholecystectomy. World J Surg 2019; 43:2728-2733. [DOI: 10.1007/s00268-019-05082-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Luciano MP, Namgoong JM, Nani RR, Nam SH, Lee C, Shin IH, Schnermann MJ, Cha J. A Biliary Tract-Specific Near-Infrared Fluorescent Dye for Image-Guided Hepatobiliary Surgery. Mol Pharm 2019; 16:3253-3260. [PMID: 31244218 DOI: 10.1021/acs.molpharmaceut.9b00453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite advances, visual inspection, palpation, and intraoperative ultrasound remain the most utilized tools during surgery today. A particularly challenging issue is the identification of the biliary system due to its complex architecture partially embedded within the liver. Fluorescence guided surgical interventions, particularly using near-infrared (NIR) wavelengths, are an emerging approach for the real-time assessment of the hepatobiliary system. However, existing fluorophores, such as the FDA-approved indocyanine green (ICG), have significant limitations for rapid and selective visualization of bile duct anatomy. Here we report a novel NIR fluorophore, BL (Bile Label)-760, which is exclusively metabolized by the liver providing high signal in the biliary system shortly after intravenous administration. This molecule was identified by first screening a small set of known heptamethine cyanines including clinically utilized agents. After finding that none of these were well-suited, we then designed and tested a small series of novel dyes within a prescribed polarity range. We validated the molecule that emerged from these efforts, BL-760, through animal studies using both rodent and swine models employing a clinically applicable imaging system. In contrast to ICG, BL-760 fluorescence revealed a high target-to-background ratio (TBR) of the cystic duct relative to liver parenchyma 5 min after intravenous injection. During hepatic resection surgery, intrahepatic ducts were clearly highlighted, and bile leakage was easily detected. In conclusion, BL-760 has highly promising properties for intraoperative navigation during hepatobiliary surgery.
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Affiliation(s)
- Michael P Luciano
- Chemical Biology Laboratory, Center for Cancer Research , National Cancer Institute , 376 Boyles Street , Frederick , Maryland 21702 , United States
| | - Jung-Man Namgoong
- Sheikh Zayed Institute for Pediatric Surgical Innovation , Children's National Health System , 111 Michigan Avenue Northwest , Washington , D.C. 20010 , United States.,Department of Surgery , University of Ulsan College of Medicine , Asan Medical Center, 88 Olympic-ro, 43-gil , Songpa-gu, Seoul 138-736 , South Korea
| | - Roger R Nani
- Chemical Biology Laboratory, Center for Cancer Research , National Cancer Institute , 376 Boyles Street , Frederick , Maryland 21702 , United States
| | - So-Hyun Nam
- Sheikh Zayed Institute for Pediatric Surgical Innovation , Children's National Health System , 111 Michigan Avenue Northwest , Washington , D.C. 20010 , United States.,Department of Surgery , Dong-A University College of Medicine , 26 Daesingongwon-Ro , Seo-Gu, Busan 49201 , South Korea
| | - Choonghee Lee
- InTheSmart Co , Center for Medical Innovation Bld , 71 Daehak-ro , Jongro-gu, Seoul , South Korea
| | - Il Hyung Shin
- InTheSmart Co , Center for Medical Innovation Bld , 71 Daehak-ro , Jongro-gu, Seoul , South Korea
| | - Martin J Schnermann
- Chemical Biology Laboratory, Center for Cancer Research , National Cancer Institute , 376 Boyles Street , Frederick , Maryland 21702 , United States
| | - Jaepyeong Cha
- Chemical Biology Laboratory, Center for Cancer Research , National Cancer Institute , 376 Boyles Street , Frederick , Maryland 21702 , United States.,Department of Pediatrics , George Washington University School of Medicine and Health Sciences , 2300 Eye Street Northwest , Washington , D.C. 20052 , United States
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de Siqueira Corradi MB, D Ávila R, Duim E, Rodrigues CIS. Risk stratification for complications of laparoscopic cholecystectomy based on associations with sociodemographic and clinical variables in a public hospital. Am J Surg 2019; 219:645-650. [PMID: 31130212 DOI: 10.1016/j.amjsurg.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cholelithiasis is the most common disease of the biliary tract. We aimed to associate complications resulting from laparoscopic cholecystectomy with patients' sociodemographic and clinical data, stratifying risk based on this association. METHODS We retrospectively reviewed the medical records of 2520 patients undergoing laparoscopic cholecystectomy from January 2013 to March 2017 at our institution. Sociodemographic, clinical, and surgical complication data were collected. Unadjusted and adjusted logistic regression models were used to determine independent factors associated with the outcomes of interest. Based on the results, we proposed a risk stratification model, a treatment flowchart, and a severity score. RESULTS Mean age was 48.9 years; 83.53% were female. Intraoperative complications occurred in 206 (8.17%) patients, and postoperative complications in 54 (2.14%). Male sex, older age, diabetes, multiple previous operations, and urgent surgery (odds ratio = 23.77) were significantly associated with surgical complications in both unadjusted and adjusted models. CONCLUSIONS We could propose a flowchart based on our risk stratification model and develop a severity score based on the association between complications of laparoscopic cholecystectomy and sociodemographic/clinical data.
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Affiliation(s)
| | - Ronaldo D Ávila
- Department of Medicine, Nephrology Division, School of Medical and Health Sciences, Pontifícia Universidade Católica de São Paulo (PUC-SP), R. Jouberte Wey, 290, Vergueiro, 18030-070, Sorocaba, SP, Brazil.
| | - Etienne Duim
- School of Public Health, Universidade de São Paulo (USP), Faculty of Health, Medicine and Life Sciences, Av. Dr Arnaldo, 715, 01246-904, São Paulo, SP, Brazil.
| | - Cibele Isaac Saad Rodrigues
- Department of Medicine, Nephrology Division and Education in Health Professions Master Program, School of Medical and Health Sciences, PUC-SP. R, Jouberte Wey, 290, Vergueiro, 18030-070, Sorocaba, SP, Brazil.
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Chehade M, Kakala B, Sinclair JL, Pang T, Al Asady R, Richardson A, Pleass H, Lam V, Johnston E, Yuen L, Hollands M. Intraoperative detection of aberrant biliary anatomy via intraoperative cholangiography during laparoscopic cholecystectomy. ANZ J Surg 2019; 89:889-894. [PMID: 31083792 DOI: 10.1111/ans.15267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the standard of treatment for symptomatic cholelithiasis. Although intraoperative cholangiography (IOC) is widely used as an adjunct to LC, there is still no worldwide consensus on the value of its routine use. Anatomical studies have shown that variations of the biliary tree are present in approximately 35% of patients with variations in right hepatic second-order ducts being especially common (15-20%). Approximately, 70-80% of all iatrogenic bile duct injuries are a consequence of misidentification of biliary anatomy. The purpose of this study was to assess the adequacy of and the reporting of IOCs during LC. METHODS IOCs obtained from 300 consecutive LCs between July 2014 and July 2016 were analysed retrospectively by two surgical trainees and confirmed by a radiologist. Biliary tree anatomy was classified from IOC films as described by Couinaud (1957) and correlated with documented findings. The accuracy of intraoperative reporting was assessed. Biliary anatomy was correlated to clinical outcome. RESULTS A total of 95% of IOCs adequately demonstrated biliary anatomy. Aberrant right sectoral ducts were identified in 15.2% of the complete IOCs, and 2.6% demonstrated left sectoral or confluence anomalies. Only 20.4% of these were reported intraoperatively. Bile leaks occurred in two patients who had IOCs (0.73%) and two who did not (7.4%). CONCLUSION Surgeons generally demonstrate biliary anatomy well on IOC but reporting of sectoral duct variation can be improved. Further research is needed to determine whether anatomical variation is related to ductal injury.
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Affiliation(s)
- Marthe Chehade
- Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Benedict Kakala
- Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Jane-Louise Sinclair
- Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Tony Pang
- Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Rafid Al Asady
- Department of Radiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Arthur Richardson
- Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Henry Pleass
- Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Vincent Lam
- Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Emma Johnston
- Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Lawrence Yuen
- Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Hollands
- Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
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40
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Abstract
The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps (e.g., fundus first technique); (8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.
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Affiliation(s)
- Vishal Gupta
- Department of Surgical Gastroenterology, Shatabdi Hospital Phase 1, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
| | - Gaurav Jain
- Transplant and HPB Surgery, the Iowa Clinic-Iowa Methodist Hospital, Des Moines, IA 50309, United States
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41
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Gupta V, Jain G. Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy. World J Gastrointest Surg 2019; 11:62-84. [PMID: 30842813 PMCID: PMC6397793 DOI: 10.4240/wjgs.v11.i2.62] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/06/2019] [Accepted: 01/23/2019] [Indexed: 02/06/2023] Open
Abstract
The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps (e.g., fundus first technique); (8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.
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Affiliation(s)
- Vishal Gupta
- Department of Surgical Gastroenterology, Shatabdi Hospital Phase 1, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Gaurav Jain
- Transplant and HPB Surgery, the Iowa Clinic-Iowa Methodist Hospital, Des Moines, IA 50309, United States
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Carr BD, Matusko N, Sandhu G, Varban OA. Cut or Do Not Cut? Assessing Perceptions of Safety During Laparoscopic Cholecystectomy Using Surgical Videos. JOURNAL OF SURGICAL EDUCATION 2018; 75:1583-1588. [PMID: 29929815 DOI: 10.1016/j.jsurg.2018.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/31/2018] [Accepted: 05/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Bile duct injury remains a serious complication of laparoscopic cholecystectomy despite established criteria for the critical view of safety (CVS). Using surgical videos, we compared surgeons' willingness to divide critical structures based on their assessment of the CVS dissection. DESIGN Participants reviewed 20 operative videos lasting 1 minute each, edited at various points of the CVS dissection. Participants stated whether the structures were safe to divide, and if not, what steps they would take to achieve an adequate dissection. Videos were independently scored using a validated scale and categorized as an "adequate" or "inadequate" dissection based on the score. Participants were blinded to CVS score and adequacy. Cohen's kappa statistic was used to evaluate inter-rater agreement and responses were compared by univariate analysis. SETTING University of Michigan, Ann Arbor, Michigan. Tertiary care university hospital. PARTICIPANTS General surgery residents (n = 13) and faculty (n = 13) at the study institution. RESULTS There was minimal agreement on willingness to divide critical structures among all participants (κ = 0.25), among faculty (κ = 0.30), and among residents (κ = 0.21). Participants were more willing to divide critical structures when videos showed an adequate CVS dissection (CVS score ≥ 4) than an inadequate dissection (CVS score ≤ 3) (60.4% vs. 16.3%, p = 0.043). For inadequate dissections, participants most commonly recommended further dissection of the hepatocystic triangle (30.8%). There was no significant difference in the rate of unsafe practices (choosing to divide critical structures for videos with an "inadequate" dissection) between faculty and residents (14.2% vs. 18.3%, p = 0.781). CONCLUSIONS There was minimal agreement on what constituted a safe CVS dissection and there was no difference in the rate of unsafe practices between trainees and faculty. Education may play a more important role than experience when building a culture of safety for laparoscopic cholecystectomy.
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Affiliation(s)
- Benjamin D Carr
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Niki Matusko
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Oliver A Varban
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Tsutsui N, Yoshida M, Nakagawa H, Ito E, Iwase R, Suzuki N, Imakita T, Ohdaira H, Kitajima M, Yanaga K, Suzuki Y. Optimal timing of preoperative indocyanine green administration for fluorescent cholangiography during laparoscopic cholecystectomy using the PINPOINT® Endoscopic Fluorescence Imaging System. Asian J Endosc Surg 2018; 11:199-205. [PMID: 29265699 PMCID: PMC6099380 DOI: 10.1111/ases.12440] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The PINPOINT® Endoscopic Fluorescence Imaging System (Novadaq, Mississauga, Canada) allows surgeons to visualize the bile ducts during laparoscopic cholecystectomy. Surgeons can continue operation while confirming the bile ducts' fluorescence with a bright-field/color image. However, strong fluorescence of the liver can interfere with the surgery. Here, we investigated the optimal timing of indocyanine green administration to allow fluorescent cholangiography to be performed without interference from the liver fluorescence. METHODS A total of 72 patients who underwent laparoscopic cholecystectomy were included in this study. The timing of indocyanine green administration was set immediately before surgery and at 3, 6, 9, 12, 15, 18, and 24 h before surgery. The luminance intensity ratios of gallbladder/liver, cystic duct/liver, and common bile duct/liver were measured using the ImageJ software (National Institutes of Health, Bethesda, USA). Visibility of the gallbladder and bile ducts was classified into three categories (grades A, B, and C) based on the degree of visibility in contrast to the liver. RESULTS The luminance intensity ratio for the gallbladder/liver, cystic duct/liver, and common bile duct/liver was ≥1 in the 15-, 18-, and 24-h groups. The proportion of cases in which evaluators classified the visibility of the gallbladder and bile ducts as grade A (best visibility) reached a peak in the 15-h group and decreased thereafter. CONCLUSIONS In the present study, the optimal timing of indocyanine green administration for fluorescent cholangiography during laparoscopic cholecystectomy using the PINPOINT Endoscopic Fluorescence Imaging System was 15 h before surgery.
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Affiliation(s)
- Nobuhiro Tsutsui
- Department of SurgeryInternational University of Health and Welfare HospitalNasushiobaraJapan,Department of SurgeryJikei University School of MedicineTokyoJapan
| | - Masashi Yoshida
- Department of SurgeryInternational University of Health and Welfare HospitalNasushiobaraJapan
| | - Hikaru Nakagawa
- Department of SurgeryInternational University of Health and Welfare HospitalNasushiobaraJapan
| | - Eisaku Ito
- Department of SurgeryInternational University of Health and Welfare HospitalNasushiobaraJapan
| | - Ryota Iwase
- Department of SurgeryInternational University of Health and Welfare HospitalNasushiobaraJapan
| | - Norihiko Suzuki
- Department of SurgeryInternational University of Health and Welfare HospitalNasushiobaraJapan
| | - Tomonori Imakita
- Department of SurgeryInternational University of Health and Welfare HospitalNasushiobaraJapan
| | - Hironori Ohdaira
- Department of SurgeryInternational University of Health and Welfare HospitalNasushiobaraJapan
| | - Masaki Kitajima
- Department of SurgeryInternational University of Health and Welfare HospitalNasushiobaraJapan
| | - Katsuhiko Yanaga
- Department of SurgeryJikei University School of MedicineTokyoJapan
| | - Yutaka Suzuki
- Department of SurgeryInternational University of Health and Welfare HospitalNasushiobaraJapan
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44
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Giménez ME, Houghton EJ, Zeledón ME, Palermo M, Acquafresca P, Finger C, Serra E. THE CRITICAL VIEW OF SAFETY PREVENTS THE APPEARANCE OF BILIARY INJURIES? ANALYSIS OF A SURVEY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1380. [PMID: 29972408 PMCID: PMC6044193 DOI: 10.1590/0102-672020180001e1380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/22/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The risk of bile duct injury (BDI) during cholecystectomy remains a concern, despite efforts proposed for increasing safety. The Critical View of Safety (CVS) has been adopted promoting to reduce its risk. AIM To perform a survey to assess the awareness of the CVS, estimating the proportion of surgeons that correctly identified its elements and its relationship with BDI. METHODS An anonymous online survey was sent to 2096 surgeons inquiring on their common practices during cholecystectomy and their knowledge of the CVS. RESULTS A total of 446 surgeons responded the survey (21%). The percentage of surgeons that correctly identified the elements of CVS was 21.8% and 24.8% among surgeons claiming to know the CVS. The percentage of surgeons that reported BDI was higher among those that incorrectly identified the elements of the CVS (p=0.03). In the multivariate analysis, career length was the most significant factor related to BDI (p=0.002). CONCLUSIONS The percentage of surgeons that correctly identified the Critical View of Safety was low, even among those who claimed to know the CVS. The percentage of surgeons that reported BDI was higher among those that incorrectly identified the elements of the CVS.
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Affiliation(s)
| | - Eduardo Javier Houghton
- Mini-Invasive Surgery, Hospital Bernardino Rivadavia, University of Buenos Aires, Staff DAICIM Foundation
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45
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van den Bos J, Wieringa FP, Bouvy ND, Stassen LPS. Optimizing the image of fluorescence cholangiography using ICG: a systematic review and ex vivo experiments. Surg Endosc 2018; 32:4820-4832. [PMID: 29777357 PMCID: PMC6208701 DOI: 10.1007/s00464-018-6233-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/09/2018] [Indexed: 12/28/2022]
Abstract
Background Though often only briefly described in the literature, there are clearly factors that have an influence on the fluorescence intensity, and thereby the usefulness of the technique. This article aims to provide an overview of the factors influencing the fluorescence intensity of fluorescence imaging with Indocyanine green, primarily focussed on NIRF guided cholangiography. Methods A systematic search was conducted to gain an overview of currently used methods in NIRF imaging in laparoscopic cholecystectomies. Relevant literature was searched to gain advice on what methods to use. Ex vivo experiments were performed to assess various factors that influence fluorescence intensity and whether the found clinical advices can be confirmed. Results ICG is currently the most widely applied fluorescent dye. Optimal ICG concentration lies between 0.00195 and 0.025 mg/ml, and this dose should be given as early as achievable—but maximum 24 h—before surgery. When holding the laparoscope closer and perpendicular to the dye, the signal is most intense. In patients with a higher BMI and/or cholecystitis, fluorescence intensity is lower, but NIRF seems to be more helpful. There are differences between various marketed fluorescence systems. Also, no uniform method to assess fluorescence intensity is available yet. Conclusions This study identified and discussed several factors that influence the signal of fluorescence cholangiography. These factors should be taken into account when using NIRF cholangiography. Also, surgeons should be aware of new dyes and clinical systems, in order to benefit most from the potential of NIRF imaging. Electronic supplementary material The online version of this article (10.1007/s00464-018-6233-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jacqueline van den Bos
- Department of Surgery, Maastricht University Medical Center, PO box 616, 6200 MD, Maastricht, The Netherlands. .,School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Fokko P Wieringa
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,imec the Netherlands, Eindhoven, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, PO box 616, 6200 MD, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center, PO box 616, 6200 MD, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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46
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Pucher PH, Brunt LM, Davies N, Linsk A, Munshi A, Rodriguez HA, Fingerhut A, Fanelli RD, Asbun H, Aggarwal R. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc 2018; 32:2175-2183. [PMID: 29556977 PMCID: PMC5897463 DOI: 10.1007/s00464-017-5974-2] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/30/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures, remains associated with significant major morbidity including bile leak and bile duct injury (BDI). The effect of changes in practice over time, and of interventions to improve patient safety, on morbidity rates is not well understood. The aim of this review was to describe current incidence rates and trends for BDI and other complications during and after LC, and to identify risk factors and preventative measures associated with morbidity and BDI. METHODS PubMed, MEDLINE, and Web of Science database searches and data extraction were conducted for studies which reported individual complications and complication rates following laparoscopic cholecystectomy in a representative population. Outcomes data were pooled. Meta-regression analysis was performed to assess factors associated with conversion, morbidity, and BDI rates. RESULTS One hundred and fifty-one studies reporting outcomes for 505,292 patients were included in the final quantitative synthesis. Overall morbidity, BDI, and mortality rates were 1.6-5.3%, 0.32-0.52%, and 0.08-0.14%, respectively. Reported BDI rates reduced over time (1994-1999: 0.69(0.52-0.84)% versus 2010-2015 0.22(0.02-0.40)%, p = 0.011). Meta-regression analysis suggested higher conversion rates in developed versus developing countries (4.7 vs. 3.4%), though a greater degree of reporting bias was present in these studies, with no other significant associations identified. CONCLUSIONS Overall, trends suggest a reduction in BDI over time with unchanged morbidity and mortality rates. However, data and reporting are heterogenous. Establishment of international outcomes registries should be considered.
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Affiliation(s)
- Philip H Pucher
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - L Michael Brunt
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Neil Davies
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Ali Linsk
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Amani Munshi
- Department of Surgery, University Hospitals St. John Medical Center, Westlake, OH, USA
| | | | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Robert D Fanelli
- Department of Surgery and Division of Gastroenterology, The Guthrie Clinic, Sayre, PA, USA
| | - Horacio Asbun
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Rajesh Aggarwal
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Office of Strategic Business Development and Partnerships, Thomas Jefferson University and Jefferson Health, Philadelphia, PA, USA
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47
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Bove A, Di Renzo RM, Palone G, Testa D, Malerba V, Bongarzoni G. Single-stage procedure for the treatment of cholecysto-choledocolithiasis: a surgical procedures review. Ther Clin Risk Manag 2018; 14:305-312. [PMID: 29503549 PMCID: PMC5824758 DOI: 10.2147/tcrm.s146461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
While laparoscopic cholecystectomy is generally accepted as the treatment of choice for simple gallbladder stones, in cases in which common bile duct stones are also present, clinical and diagnostic elements, along with intraoperative findings, define the optimal means of treatment. All available options must be accessible to the surgical team which must necessarily be multidisciplinary and include a surgeon, an endoscopist, and a radiologist in order to identify the best option for a truly personalized surgery. This review describes the different techniques and approaches used based on distinctive recommendations and factors, according to the specific cases treated and the results achieved.
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Affiliation(s)
- Aldo Bove
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Raffaella Maria Di Renzo
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Gino Palone
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Domenica Testa
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Valentina Malerba
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Giuseppe Bongarzoni
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
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48
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Kleinubing DR, Riera R, Matos D, Linhares MM. Selective versus routine intraoperative cholangiography for cholecystectomy. Hippokratia 2018. [DOI: 10.1002/14651858.cd012971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Diego R Kleinubing
- Universidade Federal do Pampa; Department of Surgery, Faculty of Medicine; Uruguaiana Rio Grande do Sul Brazil
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Cochrane Brazil; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
| | - Delcio Matos
- Escola Paulista de Medicina, Universidade Federal de São Paulo; Department of Gastroenterological Surgery; Rua Edison 278, Apto 61 Campo Belo São Paulo São Paulo Brazil 04618-031
| | - Marcelo Moura Linhares
- Universidade Federal de São Paulo; Department of Surgery; Rua Leandro Dupre, 334. Ap-21 Sao Paulo SP Brazil 04025011
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49
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Booij KAC, Coelen RJ, de Reuver PR, Besselink MG, van Delden OM, Rauws EA, Busch OR, van Gulik TM, Gouma DJ. Long-term follow-up and risk factors for strictures after hepaticojejunostomy for bile duct injury: An analysis of surgical and percutaneous treatment in a tertiary center. Surgery 2018; 163:1121-1127. [PMID: 29475612 DOI: 10.1016/j.surg.2018.01.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/16/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepaticojejunostomy is commonly indicated for major bile duct injury after cholecystectomy. The debate about the timing of hepaticojejunostomy for bile duct injury persists since data on postoperative outcomes, including postoperative strictures, are lacking. The aim of this study was to analyze short- and long-term outcomes of hepaticojejunostomy for bile duct injury, including risk factors for strictures. METHOD Analysis of outcome of hepaticojejunostomy in bile duct injury patients referred to a multidisciplinary team. RESULTS Between the years1991 and 2016, 281 patients underwent hepaticojejunostomy for bile duct injury. Clavien-Dindo grade III complications occurred in 31 patients (11%) and 90-day mortality occurred in 2 patients (0.7%). After a median follow-up of 10.5 years (interquartile range 6.7-14.8 years), clinically relevant strictures were found in 37 patients (13.2%). Strictures were treated with percutaneous dilatation in 33 patients (89.2%), and 4 patients (1.4%) were reoperated. The stricture rate in patients undergoing hepaticojejunostomy <14 days, between 14-90 days, and >90 days after bile duct injury was 15.8%, 18.7%, and 9.9%, respectively. The stricture rate for early versus intermediate and late repair did not differ (P = 0.766 and 0.431, respectively). The stricture rate for repair after 14-90 days, however, was higher compared with repair >90 days after bile duct injury (P = 0.045). In multivariable analysis male gender was the only independent variable associated with stricture formation (OR 6.7, 95% CI 1.8-25.4, P = 0.005). CONCLUSION Hepaticojejunostomy is a relatively safe treatment of bile duct injury. Timing of surgery and intermediate repair affect long-term stricture rate; most anastomotic strictures can be treated successfully with percutaneous dilation.
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Affiliation(s)
- Klaske A C Booij
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Robert J Coelen
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Philip R de Reuver
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Surgery, Radboud University, Nijmegen, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Otto M van Delden
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Erik A Rauws
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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50
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Population-Based Studies Should not be Used to Justify a Policy of Routine Cholangiography to Prevent Major Bile Duct Injury During Laparoscopic Cholecystectomy. World J Surg 2017; 41:82-89. [PMID: 27468742 DOI: 10.1007/s00268-016-3665-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Iatrogenic bile duct injury at time of cholecystectomy is a rare but devastating event. A twofold higher frequency of bile duct injury during cholecystectomy without cholangiography is reported in population-based studies. Some interpret this as a cause-and-effect relationship and thus mandate routine cholangiography. A critical appraisal of population studies is required to determine whether these studies are suitable in determining the role of routine cholangiography. The literature search was performed using combinations of the forced search terms "duct injury", "population" and "cholangiography" to identify population-based studies assessing the relationship between cholangiography and iatrogenic bile duct injury. All seven population-based studies reported a numerically higher rate of bile duct injury when an intraoperative cholangiogram was not obtained during cholecystectomy. Five predate the critical view technique. Only one was limited to laparoscopic cholecystectomy. All studies identified cholangiography as a likely marker for disease severity or surgical technique. Six studies did not demonstrate a cause-and-effect relationship by not including effect modifiers. The only study to address confounders reported the same rate of injury irrespective of the use of cholangiography. Critical appraisal of population-based studies does not support their use in justifying a policy of routine cholangiography to prevent major bile duct injury.
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