Int J Med Robot - Intra-operative fluorescent cholangiography using indocyanin green during robotic single site cholecystectomy.

Tópicos

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Resumo

CKGROUND AND STUDY AIMS: Very recently, robotic single site cholecystectomy (RSSC) has been reported feasible and safe for selected cases. While an intra-operative cholangiography can be performed, data is scarce with respect to its use. Indocyanin green (ICG) has been shown to be a viable option to visualize biliary anatomy. Since the introduction of a new near infrared camera integrated to the da Vinci Si System (Intuitive Surgical, Sunnyvale, CA), the surgeon is able to assess the biliary anatomy by a non-invasive and non-ionizing method. This paper presents the first report of ICG imaging during a RSSC.PATIENTS AND METHODS: Twelve consecutive patients presenting symptomatic cholelithiasis were prospectively enrolled. They underwent RSSC approximately 45 minutes after intravenous administration of ICG (2.5 mg). The biliary anatomy was analyzed using a near infrared camera integrated to the robot before and after the robotic dissection.RESULTS: Eight women and four men underwent the procedure. There was a port addition in one case and no peri-operative complications. Mean operative time was 85 minutes (range: 57-125). The cystic, common bile and common hepatic ducts were recognized by fluorescence imaging before the dissection in 91.7%, 50%, and 33.3% of patients, respectively. At least one structure was visualized in 100% of patients. After the completion of Calot's triangle dissection, the cystic, common bile, and common hepatic ducts were recognized in 100%, 83.3%, and 66.7% of cases respectively.CONCLUSIONS: RSSC using ICG for biliary tree fluorescence imaging can be performed safely. Fluorescent cholangiography enabled real-time identification of the extra-hepatic biliary anatomy using a near infrared camera integrated to the robot. Its routine clinical use merits further investigations.

Resumo Limpo

ckground studi aim recent robot singl site cholecystectomi rssc report feasibl safe select case intraop cholangiographi can perform data scarc respect use indocyanin green icg shown viabl option visual biliari anatomi sinc introduct new near infrar camera integr da vinci si system intuit surgic sunnyval ca surgeon abl assess biliari anatomi noninvas nonion method paper present first report icg imag rsscpatient method twelv consecut patient present symptomat cholelithiasi prospect enrol underw rssc approxim minut intraven administr icg mg biliari anatomi analyz use near infrar camera integr robot robot dissectionresult eight women four men underw procedur port addit one case periop complic mean oper time minut rang cystic common bile common hepat duct recogn fluoresc imag dissect patient respect least one structur visual patient complet calot triangl dissect cystic common bile common hepat duct recogn case respectivelyconclus rssc use icg biliari tree fluoresc imag can perform safe fluoresc cholangiographi enabl realtim identif extrahepat biliari anatomi use near infrar camera integr robot routin clinic use merit investig

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