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D'Acapito F, Cucchetti A, Solaini L, Serenari M, Framarini M, Ercolani G. Fluorescence Cholangiography Using Indocyanine Green Improves the Identification of Biliary Structures During Laparoscopic Cholecystectomy. World J Surg 2023; 47:666-673. [PMID: 36459198 DOI: 10.1007/s00268-022-06854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND This cross-sectional survey aimed to determine whether fluorescence cholangiography using indocyanine green (ICG-FC) can improve the detection of the cystic duct and the main bile duct during laparoscopic cholecystectomy (LC). METHODS The survey was distributed to 214 surgeons (residents/faculties) in 2021. The confidence in the identification of the cystic duct and of the main bile duct was elicited on a 10-point Likert scale before/after the use of ICG-FC. This was repeated for three LCs ranging from a procedure deemed easy to a LC for acute cholecystitis. RESULTS There were 149 responses. ICG-FC increased the responders' confidence in identifying the cystic duct, raising the median value from 6 (IQR, 5-8) with white light up to 9 (IQR, 9-10) with ICG-FC (paired p < 0.001). This increase was even more evident when identifying the main bile duct, where the median confidence value increased from 5 (IQR, 4-7) with white light to 9 (IQR, 8-10) with the use of ICG-FC (p < 0.001). ICG-FC significantly increased the detection of residents of the main bile duct in case of intermediate difficulty LCs and in LCs for acute cholecystitis. CONCLUSIONS The results support that the use of near-infrared imaging can ameliorate detection of biliary structures, especially of the main bile duct and this was particularly true for young surgeons and in more complex situations.
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Affiliation(s)
- Fabrizio D'Acapito
- General and Oncologic Surgery, Morgagni - Pierantoni Hospital, Forli, Italy
| | - Alessandro Cucchetti
- General and Oncologic Surgery, Morgagni - Pierantoni Hospital, Forli, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Leonardo Solaini
- General and Oncologic Surgery, Morgagni - Pierantoni Hospital, Forli, Italy.
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
| | - Matteo Serenari
- General Surgery and Transplantation Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Massimo Framarini
- General and Oncologic Surgery, Morgagni - Pierantoni Hospital, Forli, Italy
| | - Giorgio Ercolani
- General and Oncologic Surgery, Morgagni - Pierantoni Hospital, Forli, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Via Albertoni 15, 40138, Bologna, Italy
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Ercolani G, Solaini L, D’Acapito F, Isopi C, Pacilio CA, Moretti C, Agostini V, Cucchetti A. Implementation of a patient blood management in an Italian City Hospital: is it effective in reducing the use of red blood cells? Updates Surg 2023; 75:245-253. [PMID: 36310328 PMCID: PMC9834377 DOI: 10.1007/s13304-022-01409-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/21/2022] [Indexed: 01/16/2023]
Abstract
To evaluate the effect of patient blood management (PBM) since its introduction, we analyzed the need for transfusion and the outcomes in patients undergoing abdominal surgery for different types of tumor pre- and post-PBM. Patients undergoing elective gastric, liver, pancreatic, and colorectal surgery between 2017 and 2020 were included. The implementation of the PBM program was completed on May 1, 2018. The patients were grouped as follows: those who underwent surgery before the implementation of the program (pre-PBM) versus after the implementation (post-PBM). A total of 1302 patients were included in the analysis (445 pre-PBM vs. 857 post-PBM). The number of transfused patients per year decreased significantly after the introduction of PBM. A strong tendency for a decreased incidence of transfusion was evident in gastric and pancreatic surgery and a similar decrease was statistically significant in liver surgery. With regard to gastric surgery, a single-unit transfusion scheme was used more frequently in the post-PBM group (7.7% vs. 55% after PBM; p = 0.049); this was similar in liver surgery (17.6% vs. 58.3% after PBM; p = 0.04). Within the subgroup of patients undergoing liver surgery, a significant reduction in the use of blood transfusion (20.5% vs. 6.7%; p = 0.002) and a decrease in the Hb trigger for transfusion (8.5, 8.2-9.5 vs. 8.2, 7.7-8.4 g/dl; p = 0.039) was reported after the PBM introduction. After the implementation of a PBM protocol, a significant reduction in the number of patients receiving blood transfusion was demonstrated, with a strong tendency to minimize the use of blood products for most types of oncologic surgery.
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Affiliation(s)
- Giorgio Ercolani
- grid.415079.e0000 0004 1759 989XDepartment of Medical and Surgical Sciences (DIMEC), University of Bologna, Morgagni-Pierantoni Hospital, Via C. Forlanini 34, Forlì, Italy ,grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Leonardo Solaini
- grid.415079.e0000 0004 1759 989XDepartment of Medical and Surgical Sciences (DIMEC), University of Bologna, Morgagni-Pierantoni Hospital, Via C. Forlanini 34, Forlì, Italy ,grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Fabrizio D’Acapito
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Claudio Isopi
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Carlo Alberto Pacilio
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Cinzia Moretti
- grid.415079.e0000 0004 1759 989XImmunohematology and Transfusion Medicine, Morgagni Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Vanessa Agostini
- grid.410345.70000 0004 1756 7871Transfusion Medicine Department, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Cucchetti
- grid.415079.e0000 0004 1759 989XDepartment of Medical and Surgical Sciences (DIMEC), University of Bologna, Morgagni-Pierantoni Hospital, Via C. Forlanini 34, Forlì, Italy ,grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni Pierantoni Hospital, Ausl Romagna, Forlì, Italy
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