Mohsen Amr, Elbasiouny Mahmoud S, El-Shazli Mostafa, Azmy Osama, Amr Ahmed
Cairo University, Cairo, Egypt.
Cairo University, Cairo, Egypt
Surg Innov. 2016 Jun;23(3):261-5. doi: 10.1177/1553350615610652. Epub 2015 Nov 13.
Background This work studied the diagnostic effectiveness of a new technology and device to augment visualization of bile ducts at laparoscopic cholecystectomy. It depends on excitation of fluorescein in bile by ultraviolet light to get green fluorescent light emanating from these ducts. Methods Forty laparoscopic cholecystectomy patients received fluorescein sodium injections either in the gallbladder or intravenously, followed by exposure of the expected bile ducts area to ultraviolet light that was delivered by a specially designed device. Neutral observing surgeons were asked to judge whether or not they could see fluorescent bile ducts early in the operation before they were displayed by dissection. Accordingly, specificity, sensitivity, likelihood ratios, and predictive values of the technique were calculated. Results Fluorescent bile ducts were seen at an earlier stage than their detection by dissection in 33 out of 40 operations. The technique had 100% specificity, 82.5% sensitivity, 0.18 negative likelihood ratio, 100% positive predictive value, and 85.11% negative predictive value. There were no complications related to the technique. Conclusions The developing ultraviolet/fluorescein technique is helpful in early localization of bile ducts at laparoscopic cholecystectomy. When fluorescence is detected in the field, the technique can be completely relied on to denote the position of bile ducts. In a few cases fluorescence is not detected. Here further development of the device is the need to improve its sensitivity. Otherwise, the technique is quite simple and safe.
背景 本研究旨在探讨一种新技术及设备在腹腔镜胆囊切除术中增强胆管可视化的诊断效果。该技术通过紫外线激发胆汁中的荧光素，使胆管发出绿色荧光。方法 40例接受腹腔镜胆囊切除术的患者，分别经胆囊或静脉注射荧光素钠，然后用专门设计的设备对预期的胆管区域进行紫外线照射。由中立的观察外科医生判断在手术早期、胆管被解剖显露之前，是否能看到荧光胆管。据此计算该技术的特异性、敏感性、似然比及预测值。结果 在40例手术中，有33例荧光胆管比解剖显露更早被发现。该技术的特异性为100%，敏感性为82.5%，阴性似然比为0.18，阳性预测值为100%，阴性预测值为85.11%。该技术无相关并发症。结论 正在研发的紫外线/荧光素技术有助于在腹腔镜胆囊切除术中早期定位胆管。当在术野中检测到荧光时，该技术可完全依赖于指示胆管位置。少数情况下未检测到荧光。在此需要进一步改进设备以提高其敏感性。否则，该技术操作简单且安全。
