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Randomized Trial of Near-infrared Incisionless Fluorescent Cholangiography.
- Source :
- Annals of Surgery; Dec2019, Vol. 270 Issue 6, p992-999, 8p
- Publication Year :
- 2019
-
Abstract
- Background: Incisionless near-infrared fluorescent cholangiography (NIFC) is emerging as a promising tool to enhance the visualization of extrahepatic biliary structures during laparoscopic cholecystectomies. Methods: We conducted a single-blind, randomized, 2-arm trial comparing the efficacy of NIFC (n = 321) versus white light (WL) alone (n = 318) during laparoscopic cholecystectomy. Using the KARL STORZ Image1 S imaging system with OPAL1 technology for NIR/ICG imaging, we evaluated the detection rate for 7 biliary structures--cystic duct (CD), right hepatic duct (RHD), common hepatic duct, common bile duct, cystic common bile duct junction, cystic gallbladder junction (CGJ), and accessory ducts --before and after surgical dissection. Secondary calculations included multivariable analysis for predictors of structure visualization and comparing intergroup biliary duct injury rates. Results: Predissection detection rates were significantly superior in the NIFC group for all 7 biliary structures, ranging from 9.1% versus 2.9% to 66.6% versus 36.6% for the RHD and CD, respectively, with odds ratios ranging from 2.3 (95% CI 1.6-3.2) for the CGJ to 3.6 (1.6-9.3) for the RHD. After dissection, similar intergroup differences were observed for all structures except CD and CGJ, for which no differences were observed. Significant odds ratios ranged from 2.4 (1.7-3.5) for the common hepatic duct to 3.3 (1.3-10.4) for accessory ducts. Increased body mass index was associated with reduced detection of most structures in both groups, especially before dissection. only 2 patients, both in the WL group, sustained a biliary duct injury. Conclusions: In a randomized controlled trial, NIFC was statistically superior to WL alone visualizing extrahepatic biliary structures during laparo-scopic cholecystectomy. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00034932
- Volume :
- 270
- Issue :
- 6
- Database :
- Supplemental Index
- Journal :
- Annals of Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 143896652
- Full Text :
- https://doi.org/10.1097/SLA.0000000000003178