Utility of near infrared fluorescent cholangiography in detecting biliary structures during challenging minimally invasive cholecystectomy

The role of fluorescent cholangiography to improve operative safety in different severity degrees of acute cholecystitis during emergency laparoscopic cholecystectomy: a prospective cohort study

BACKGROUND

Currently, there is limited scientific evidence regarding the effectiveness of fluorescent cholangiography in emergency cholecystectomy for acute cholecystitis. The primary aim of this study was to assess the efficacy of near-infrared fluorescent cholangiography (NIRF-C) in different severity degrees of acute cholecystitis.

MATERIALS AND METHODS

Inclusion criteria were patients with a clinical and radiological (abdominal ultrasound and/or computed tomography) diagnosis of acute cholecystitis based on the revised 2018 Tokyo guidelines who underwent laparoscopic cholecystectomy within 24-72 h from the onset of symptoms and patients with ASA score of 0-3. NIRF-C was performed at three-time points during laparoscopic cholecystectomy: (i) following exposure of Calot's triangle, prior to any dissection; (ii) after partial dissection of Calot's triangle; and (iii) after complete dissection of Calot's triangle. The intraoperative severity degree of acute cholecystitis was assessed according to the American Association of Surgery for Trauma (AAST) classification.

RESULTS

NIRF-C was successfully performed in all 81 consecutive patients who underwent emergency laparoscopic cholecystectomy. The cystic duct was identified by NIRF-C in 46 (56.8%) and 77 (95.1%) of the 81 patients before and after Calot's dissection, respectively. The common hepatic duct and common bile duct were successfully identified in 11 (13.6%) and 32 patients (39.5%) before Calot's dissection, respectively, and in 45 (55.6%) and 76 patients (93.8%) after complete Calot's dissection, respectively. When comparing the visualization rate of biliary structures before and after Calot dissection in different severity degrees of cholecystitis, the authors found a statistically significant difference in nongangrenous (AAST I) versus gangrenous and complicated forms (AAST II-V) for all biliary structures, both before and after Calot's dissection.

CONCLUSIONS

The study indicates that the use of fluorescence cholangiography during emergency laparoscopic cholecystectomy for acute cholecystitis may represent a valuable and useful tool for intraoperative visualization of the extrahepatic biliary tract.