Daskalaki Despoina, Fernandes Eduardo, Wang Xiaoying, Bianco Francesco Maria, Elli Enrique Fernando, Ayloo Subashini, Masrur Mario, Milone Luca, Giulianotti Pier Cristoforo
University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
Surg Innov. 2014 Dec;21(6):615-21. doi: 10.1177/1553350614524839. Epub 2014 Mar 9.
BACKGROUND/AIM: Laparoscopic cholecystectomy is currently the gold standard treatment for gallstone disease. Bile duct injury is a rare and severe complication of this procedure, with a reported incidence of 0.4% to 0.8% and is mostly a result of misperception and misinterpretation of the biliary anatomy. Robotic cholecystectomy has proven to be a safe and feasible approach. One of the latest innovations in minimally invasive technology is fluorescent imaging using indocyanine green (ICG). The aim of this study is to evaluate the efficacy of ICG and the Da Vinci Fluorescence Imaging Vision System in real-time visualization of the biliary anatomy.
A total of 184 robotic cholecystectomies with ICG fluorescence cholangiography were performed between July 2011 and February 2013. All patients received a dose of 2.5 mg of ICG 45 minutes prior to the beginning of the surgical procedure. The procedures were multiport or single port depending on the case.
No conversions to open or laparoscopic surgery occurred in this series. The overall postoperative complication rate was 3.2%. No biliary injuries occurred. ICG fluorescence allowed visualization of at least 1 biliary structure in 99% of cases. The cystic duct, the common bile duct, and the common hepatic duct were successfully visualized with ICG in 97.8%, 96.1%, and 94% of cases, respectively.
ICG fluorescent cholangiography during robotic cholecystectomy is a safe and effective procedure that helps real-time visualization of the biliary tree anatomy.
背景/目的：腹腔镜胆囊切除术目前是胆结石疾病的金标准治疗方法。胆管损伤是该手术罕见但严重的并发症，报道的发生率为0.4%至0.8%，主要是由于对胆道解剖结构的误解和误判所致。机器人胆囊切除术已被证明是一种安全可行的方法。微创技术的最新创新之一是使用吲哚菁绿（ICG）的荧光成像。本研究的目的是评估ICG和达芬奇荧光成像视觉系统在实时可视化胆道解剖结构方面的疗效。
2011年7月至2013年2月期间共进行了184例采用ICG荧光胆管造影的机器人胆囊切除术。所有患者在手术开始前45分钟接受2.5毫克ICG的剂量。根据具体情况，手术采用多端口或单端口。
本系列中未发生转为开放手术或腹腔镜手术的情况。总体术后并发症发生率为3.2%。未发生胆管损伤。ICG荧光在99%的病例中能够可视化至少1个胆道结构。ICG分别在97.8%、96.1%和94%的病例中成功可视化了胆囊管、胆总管和肝总管。
机器人胆囊切除术中的ICG荧光胆管造影是一种安全有效的方法，有助于实时可视化胆管树解剖结构。
