Rungsakulkij N, Thewmorakot S, Suragul W, Vassanasiri W, Tangtawee P, Muangkaew P, Mingphruedhi S, Aeesoa S. Fluorescence cholangiography enhances surgical residents’ biliary delineation skill for laparoscopic cholecystectomies. World J Gastrointest Surg 2020; 12(3): 93-103 [PMID: 32218892 DOI: 10.4240/wjgs.v12.i3.93]
Corresponding Author of This Article
Wikran Suragul, FRCS (Gen Surg), MD, Doctor, Lecturer, Surgeon, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Praram VI Road, Ratchathewi, Bangkok 10400, Thailand. wikran.sur@mahidol.ac.th
Research Domain of This Article
Surgery
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Narongsak Rungsakulkij, Siraprapa Thewmorakot, Wikran Suragul, Watoo Vassanasiri, Pongsatorn Tangtawee, Paramin Muangkaew, Somkit Mingphruedhi, Suraida Aeesoa, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Rungsakulkij N designed the study, collected and interpreted the data, and wrote the paper; Thewmorakot S collected the data; Suragul W collected the data and wrote the paper; Vassanasiri W collected the data, Mingphruedhi S collected and analyzed the data; Tangtawee P collected and analyzed the data; Muangkaew P collected the data; and Aeesoa S analyzed the data.
Institutional review board statement: The study was reviewed and approved by the Ramathibodi Hospital Institutional Review Board Committee on Human Rights Related to Research Involving Human Subjects (protocol number ID MURA2018/558).
Informed consent statement: The population in this study signed inform consent.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE-statement, and the manuscript was prepared and revised according to the STROBE-statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wikran Suragul, FRCS (Gen Surg), MD, Doctor, Lecturer, Surgeon, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Praram VI Road, Ratchathewi, Bangkok 10400, Thailand. wikran.sur@mahidol.ac.th
Received: October 17, 2019 Peer-review started: October 17, 2019 First decision: December 4, 2019 Revised: December 19, 2019 Accepted: January 19, 2020 Article in press: January 19, 2020 Published online: March 27, 2020 Processing time: 134 Days and 1.1 Hours
Abstract
BACKGROUND
Laparoscopic cholecystectomy (LC) is a minimally invasive procedure, often performed by surgical residents (SRs). Fluorescence cholangiography (FC) enables real-time identification of biliary anatomy.
AIM
To investigate the benefit of FC for enhancing SRs’ identification skills.
METHODS
Prospective data was collected from January 2018 to June 2018 at our hospital. The study cohorts were the SRs (study group, n = 15) and the surgical staff (SS; control group, n = 9). Participants were assigned to watch videos of LCs with FC from five different patients who had gallbladder disease, and identify structures in the video clips (including cystic duct, common bile duct, common hepatic duct, and cystic artery), first without FC, and then with FC.
RESULTS
In the without-FC phase, the overall misidentification rate by SRs (21.7%) was greater than that of the SS (11.8%; P = 0.018), However, in the FC phase, the two groups did not significantly differ in misidentification rates (23.3% vs 23.3%, P = 0.99). Paired-structure analysis of the without-FC and with-FC phases for the SR group found a significantly higher misidentification rate in the without-FC phase than the with-FC phase (21.9% vs 10.9%; P < 0.01). However, misidentification rates in the with-FC phase did not significantly differ between SRs and SS.
CONCLUSION
FC enhanced identification skills of inexperienced surgeons during LC compared with conventional training. Combined with simulation-based video training, FC is a promising tool for enhancing technical and decision skills of trainees and inexperienced surgeons.
Core tip: Laparoscopic cholecystectomy (LC) is often performed by surgical residents. Avoiding bile duct injury (BDI) is a critical aspect of learning to perform this procedure safely. Landmark misperception is a high-risk factor for bile duct injury. Fluorescence cholangiography (FC) enables real-time identification of biliary anatomy during LC. We studied changes in biliary identification skills among surgical residents when FC was applied during LC, with staff surgeons as the control group. FC is a promising tool for enhancing biliary identification skills of surgeons-in-training.
