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首页> 外文期刊>Surgical Endoscopy >Combined vascular and biliary fluorescence imaging in laparoscopic cholecystectomy
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Combined vascular and biliary fluorescence imaging in laparoscopic cholecystectomy

机译：腹腔镜胆囊切除术中血管和胆道荧光联合成像

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Background: Bile duct injury in patients undergoing laparoscopic cholecystectomy is a rare but serious complication. Concomitant vascular injury worsens the outcome of bile duct injury repair. Near-infrared fluorescence imaging using indocyanine green (ICG) is a promising, innovative, and noninvasive method for the intraoperative identification of biliary and vascular anatomy during cholecystectomy. This study assessed the practical application of combined vascular and biliary fluorescence imaging in laparoscopic gallbladder surgery for early biliary tract delineation and arterial anatomy confirmation. Methods: Patients undergoing elective laparoscopic cholecystectomy were enrolled in this prospective, single-institutional study. To delineate the major bile ducts and arteries, a dedicated laparoscope, offering both conventional and fluorescence imaging, was used. ICG (2.5 mg) was administered intravenously immediately after induction of anesthesia and in half of the patients repeated at establishment of critical view of safety for concomitant arterial imaging. During dissection of the base of the gallbladder and the cystic duct, the extrahepatic bile ducts were visualized. Intraoperative recognition of the biliary structures was registered at set time points, as well as visualization of the cystic artery after repeat ICG administration. Results: Thirty patients were included. ICG was visible in the liver and bile ducts within 20 minutes after injection and remained up to approximately 2 h, using the ICG-filter of the laparoscope. In most cases, the common bile duct (83 %) and cystic duct (97 %) could be identified significantly earlier than with conventional camera mode. In 13 of 15 patients (87 %), confirmation of the cystic artery was obtained successfully after repeat ICG injection. No per- or postoperative complications occurred as a consequence of ICG use. Conclusion: Biliary and vascular fluorescence imaging in laparoscopic cholecystectomy is easily applicable in clinical practice, can be helpful for earlier visualization of the biliary tree, and is useful for the confirmation of the arterial anatomy.
机译：背景：腹腔镜胆囊切除术患者的胆管损伤是一种罕见但严重的并发症。伴随的血管损伤使胆管损伤修复的结果恶化。使用吲哚菁绿（ICG）的近红外荧光成像是胆囊切除术中胆道和血管解剖学术中鉴定的一种有前途，创新且无创的方法。这项研究评估了在腹腔镜胆囊手术中早期胆道划定和动脉解剖学证实的血管和胆道荧光成像相结合的实际应用。方法：接受选择性腹腔镜胆囊切除术的患者参加了这项前瞻性，单机构研究。为了描绘主要的胆管和动脉，使用了可同时提供常规和荧光成像的专用腹腔镜。麻醉诱导后立即静脉注射ICG（2.5 mg），一半的患者在确定动脉造影安全性的临界点时再次进行静脉注射。在解剖胆囊底部和胆囊管期间，可以看到肝外胆管。术中在设定的时间点记录了胆道结构的术中识别，并在重复ICG给药后可视化了胆囊动脉。结果：纳入30例患者。注射后20分钟内，ICG在肝和胆管中可见，使用腹腔镜的ICG过滤器可保持约2小时。在大多数情况下，与传统的摄像头模式相比，胆总管（83％）和胆囊管（97％）的识别时间要早得多。 15例患者中有13例（87％）在重复ICG注射后成功获得了胆囊动脉的确认。使用ICG不会导致术前或术后并发症。结论：腹腔镜胆囊切除术中胆道和血管的荧光成像很容易在临床上应用，有助于胆道树的早期可视化，并有助于确定动脉的解剖结构。

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