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| Name | Flourescent cholangiography-ICG use in Laparoscopic cholecystectomy.Dr Rajesh Patil |
| Video Uploader | Video From Dr Rajesh Patil |
| Upload Date | This Video Uploaded At 18-03-2020 07:37:28 |
| Video Discription | Cholecystectomy is one of the most commonly performed procedures in general surgery Bile duct injury is the most feared complication during laparoscopic cholecystectomy. The lifetime risk bile duct injury following laparoscopic cholecystectomy for gallbladder stones without acute inflammation in the hands of an experienced surgeon has been reported to be about 0.4% . Laparoscopic cholecystectomy for acute cholecystitis has been shown to be associated with a much higher risk of bile duct injury with rates as high as 4% being reported depending on the extent of gallbladder inflammation. The critical view of safety and dissection within the triangle of calot constitute the most commonly employed means of prevention or reducing bile duct injury . Intraoperative sonographic and radiographic examination of the biliary tree constitute standard methods for studying the biliary anatomy during surgery. Despite these measures, bile duct injury still remains a serious problem. Real-time intraoperative imaging using indocyanine green (ICG) might reduce the risk of bile duct injury by improving visualization of the biliary tree during laparoscopic cholecystectomy. Intraoperative fluorescent imaging with indocyanine green (ICG) has been also employed for confirming the patency of vascular reconstruction surgery, liver transplantation, anastomosis of the gastrointestinal tract, brain aneurysms, identification of sentinel lymph node navigation, and hepatocellular carcinoma detection ICG is a water soluble tricarbocyanine dye. Following intravenous injection, it rapidly and completely binds to albumin and is selectively taken up by hepatocytes and excreted into the bile.After binding to proteins, such as albumin, ICG normally emits light in the infrared region of the electromagnetic spectrum at approximately 835 nm. An infrared camera detects infrared light identified as strong fluorescence in response to ICG. The advantages of this method are no special requirements with regard to the arrangement of X-ray equipment and no radioactivity exposure. Moreover, this method is very useful in the verification of biliary anatomy without the risk of bile duct and blood vessel injury. The disadvantage of this method is the difficulty in identifying CBD stones. However, this problem can be resolved with preoperative MRCP, computed tomography, or ultrasonography examination. laparoscopic cholecystectomy was performed with ICG given via intravenous infusion one hour prior to surgery. Fluorescence imaging was performed using the endoscopic fluorescence imaging system .The triangle of calot was exposed to display the biliary tree. This is followed by dissection of the triangle of calots to expose the cystic duct and artery. Additional, the cystic artery can be independently visualized a few minutes following ICG injection. Hereafter, both structures are safely clipped and divided. The gallbladder is then dissected off the liver as usually. Conclusion Laparoscopic cholecystectomy with real-time indocyanine green fluorescence cholangiography enables a better visualization and identification of biliary tree and therefore should be considered as a means of increasing the safety of laparoscopic cholecystectomy. |
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