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Fluorescent imaging of the biliary tract during laparoscopic cholecystectomy.

Scroggie DL, Jones C - Ann Surg Innov Res (2014)

Bottom Line: The introduction of laparoscopic cholecystectomy was associated with increased incidences of bile duct injury.The primary cause appears to be misidentification of the biliary anatomy.There has been interest in the use of fluorescent agents excreted via the biliary system to enable real-time intra-operative imaging, to aid the laparoscopic surgeon in correctly interpreting the anatomy.

View Article: PubMed Central - HTML - PubMed

Affiliation: UCL Division of Surgery & Interventional Science, 9th Floor, Royal Free Hospital, Pond Street, London NW3 2QG, United Kingdom.

ABSTRACT
The introduction of laparoscopic cholecystectomy was associated with increased incidences of bile duct injury. The primary cause appears to be misidentification of the biliary anatomy. Routine intra-operative cholangiography has been recommended to reduce accidental duct injury, although in practice it is more often reserved for selected cases. There has been interest in the use of fluorescent agents excreted via the biliary system to enable real-time intra-operative imaging, to aid the laparoscopic surgeon in correctly interpreting the anatomy. The primary aim of this review is to evaluate the ability of fluorescent cholangiography to identify important biliary anatomy intra-operatively. Secondary aims are to investigate its ability to detect important intra-operative pathology such as bile leaks, identify potential alternative fluorophores, and evaluate the evidence regarding patient outcomes.

No MeSH data available.


Related in: MedlinePlus

Principle of fluorescent cholangiography. A source of near-infrared light (A) emits an excitation wave (B), which is directed towards the fluorophore-filled biliary tree at (C). The fluorophore, shown bound to a protein, is excited (D), causing emission of a longer wavelength (E). A filter (F) removes unwanted shorter wavelengths. An image of the fluorescing biliary tree is formed on the charge-coupled device (G), which is then processed for viewing by suitable electronics.
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Figure 1: Principle of fluorescent cholangiography. A source of near-infrared light (A) emits an excitation wave (B), which is directed towards the fluorophore-filled biliary tree at (C). The fluorophore, shown bound to a protein, is excited (D), causing emission of a longer wavelength (E). A filter (F) removes unwanted shorter wavelengths. An image of the fluorescing biliary tree is formed on the charge-coupled device (G), which is then processed for viewing by suitable electronics.

Mentions: The first intra-operative use of FC in humans was described by Ishizawa et al. [5]. The method involved the administration of indocyanine green (ICG) by either intra-biliary injection, or intravenous injection before surgery. ICG binds to proteins present in bile, and is excreted exclusively by the liver when administered intravenously. The excitation of protein-bound ICG by near-infrared light causes it to fluoresce, thereby delineating components of the biliary system to the surgeon. This is accomplished by the use of a specialised camera system, which illuminates the target with near-infrared light and filters the reflected wavelengths, such that the fluorescing ICG is clearly observed. The principle of FC is illustrated in FigureĀ 1.


Fluorescent imaging of the biliary tract during laparoscopic cholecystectomy.

Scroggie DL, Jones C - Ann Surg Innov Res (2014)

Principle of fluorescent cholangiography. A source of near-infrared light (A) emits an excitation wave (B), which is directed towards the fluorophore-filled biliary tree at (C). The fluorophore, shown bound to a protein, is excited (D), causing emission of a longer wavelength (E). A filter (F) removes unwanted shorter wavelengths. An image of the fluorescing biliary tree is formed on the charge-coupled device (G), which is then processed for viewing by suitable electronics.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4196113&req=5

Figure 1: Principle of fluorescent cholangiography. A source of near-infrared light (A) emits an excitation wave (B), which is directed towards the fluorophore-filled biliary tree at (C). The fluorophore, shown bound to a protein, is excited (D), causing emission of a longer wavelength (E). A filter (F) removes unwanted shorter wavelengths. An image of the fluorescing biliary tree is formed on the charge-coupled device (G), which is then processed for viewing by suitable electronics.
Mentions: The first intra-operative use of FC in humans was described by Ishizawa et al. [5]. The method involved the administration of indocyanine green (ICG) by either intra-biliary injection, or intravenous injection before surgery. ICG binds to proteins present in bile, and is excreted exclusively by the liver when administered intravenously. The excitation of protein-bound ICG by near-infrared light causes it to fluoresce, thereby delineating components of the biliary system to the surgeon. This is accomplished by the use of a specialised camera system, which illuminates the target with near-infrared light and filters the reflected wavelengths, such that the fluorescing ICG is clearly observed. The principle of FC is illustrated in FigureĀ 1.

Bottom Line: The introduction of laparoscopic cholecystectomy was associated with increased incidences of bile duct injury.The primary cause appears to be misidentification of the biliary anatomy.There has been interest in the use of fluorescent agents excreted via the biliary system to enable real-time intra-operative imaging, to aid the laparoscopic surgeon in correctly interpreting the anatomy.

View Article: PubMed Central - HTML - PubMed

Affiliation: UCL Division of Surgery & Interventional Science, 9th Floor, Royal Free Hospital, Pond Street, London NW3 2QG, United Kingdom.

ABSTRACT
The introduction of laparoscopic cholecystectomy was associated with increased incidences of bile duct injury. The primary cause appears to be misidentification of the biliary anatomy. Routine intra-operative cholangiography has been recommended to reduce accidental duct injury, although in practice it is more often reserved for selected cases. There has been interest in the use of fluorescent agents excreted via the biliary system to enable real-time intra-operative imaging, to aid the laparoscopic surgeon in correctly interpreting the anatomy. The primary aim of this review is to evaluate the ability of fluorescent cholangiography to identify important biliary anatomy intra-operatively. Secondary aims are to investigate its ability to detect important intra-operative pathology such as bile leaks, identify potential alternative fluorophores, and evaluate the evidence regarding patient outcomes.

No MeSH data available.


Related in: MedlinePlus