Department of Digestive and General Surgery, Uonuma Kikan Hospital, Niigata, Japan.
Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
Asian J Endosc Surg. 2021 Oct;14(4):767-774. doi: 10.1111/ases.12939. Epub 2021 Apr 5.
Near-infrared fluorescence cholangiography during a laparoscopic cholecystectomy has become widely accepted as a useful auxiliary tool to visualize the extrahepatic biliary structures. We investigated the feasibility and educational value of a method with longer interval between the administration of indocyanine green and the imaging of these structures.
Approximately 18 hours before their surgery, patients (n = 51) were intravenously administered 0.25 mg/kg of indocyanine green. Each laparoscopic cholecystectomy was performed under fluorescence imaging in combination with white-light imaging. Operative outcomes including visualization of the extrahepatic biliary structures and operative time were compared between the patients on whom board-certified surgeons operated (feasibility phase; n = 18) and the patients on whom a surgery resident operated (educational phase; n = 33).
There were no adverse events related to the longer interval method. The visualization rates of extrahepatic biliary structures were comparable between the two phases. Both the mean time to divide the cystic duct and the mean time to remove the gallbladder in the educational phase were significantly longer than those in the feasibility phase (68.2 vs 24.4 minutes and 30.2 vs 15.8 minutes, P < .001 each). There was no significant difference in other operative outcomes. The operative time learning curve did not decrease with a resident's experience.
Fluorescence cholangiography with the longer interval method was feasible and could identify the extrahepatic biliary structures irrespective of the surgeon's experience; however, it did not decrease the operative time with experience.
腹腔镜胆囊切除术中近红外荧光胆管造影已广泛应用于显示肝外胆管结构，成为一种有用的辅助工具。我们研究了一种在给予吲哚菁绿和这些结构成像之间间隔时间较长的方法的可行性和教育价值。
患者（n=51）在手术前约 18 小时静脉注射 0.25mg/kg 的吲哚菁绿。每例腹腔镜胆囊切除术均在荧光成像与白光成像联合下进行。比较由认证外科医生操作的患者（可行性阶段；n=18）和由外科住院医师操作的患者（教育阶段；n=33）的手术结果，包括肝外胆管结构的可视化和手术时间。
没有与较长间隔方法相关的不良事件。两个阶段的肝外胆管结构可视化率相当。教育阶段中切断胆囊管的平均时间和切除胆囊的平均时间均明显长于可行性阶段（68.2 分钟比 24.4 分钟和 30.2 分钟比 15.8 分钟，P<.001）。其他手术结果无显著差异。随着住院医师经验的增加，手术时间学习曲线并未下降。
较长间隔法荧光胆管造影是可行的，无论外科医生的经验如何，都可以识别肝外胆管结构；然而，经验并不能减少手术时间。
