What is it about?

Today, innovations in surgical technology is augmenting the surgeon’s “eye” in order to improve the correct identification of the critical view of safety (CVS) during laparoscopic cholecystectomy. It is a perfect combination of surgical anatomy and technological innovation. Near-infrared fluorescent cholangiography could well represent a useful method to identify the CVS with the aid of real-time fluorescent vision.

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Why is it important?

With the use of fluorescent cholangiography, the common hepatic duct and the common bile duct can be often visualized without the direct exposure of these structures. Only biliary structures can emit fluorescence, and this property could help in distinguishing biliary and vascular elements intraoperatively and in recognizing anatomical biliary variants during dissection, by reducing the risk of bile duct injuries.

Perspectives

While waiting for the results of some ongoing randomized trials, we are strongly convinced that this technique will become a gold standard in the near future. Available data are demonstrating the efficacy of NIRF-C navigation, particularly in case of cholecystitis. However, we feel that, given the simplicity and the low-costs per case of such technique, this should be applied routinely, to every day cholecystectomy and not reserved only to complex cases.

MD PhD FACS Antonio Pesce
Universita degli Studi di Ferrara

Read the Original

This page is a summary of: Critical View of Safety During Laparoscopic Cholecystectomy: From the Surgeon’s Eye to Fluorescent Vision, Surgical Innovation, March 2018, SAGE Publications,
DOI: 10.1177/1553350618763200.
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