Incisionless fluorescent cholangiography (IFC): a pilot survey of surgeons on procedural familiarity, practices, and perceptions View Full Text


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Article Info

DATE

2019-05-06

AUTHORS

Fernando Dip, Luis Sarotto, Mayank Roy, Aaron Lee, Emanuelle LoMenzo, Matthew Walsh, Thomas Carus, Sylke Schneider, Luigi Boni, Takeaki Ishizawa, Nohiro Kokudo, Kevin White, Raul J. Rosenthal

ABSTRACT

BackgroundIncisionless fluorescent cholangiography (IFC) has recently been proven feasible, safe, and efficacious as an intraoperative procedure to help identify extrahepatic bile ducts during laparoscopic cholecystectomies (LC). We conducted a pilot survey of 51 surgeons attending an international conference who perform endoscopic cholecystectomies to identify their typical LC practices, and perceptions of IFC.MethodsAn international panel of ten IFC experts, all with > 500 prior IFC procedures and related research publications, convened during the 4th International Congress of Fluorescence-Guided Surgery in Boca Raton, Florida in February 2017. The panel was charged with developing questions about LC practices and experience with IFC, and perceptions regarding its advantages, barriers to use, and indications. These questions then were asked to other congress attendees during one of the didactic sessions using an online polling application. Attendees, who ranged from zero to considerable experience performing IFC, accessed the survey via their portable devices.ResultsOf the 51 survey participants, 51% were from North America; 77% identified themselves as general/minimally invasive surgeons, and roughly 60% performed under 50 cholecystectomies/year. Only 12% performed routine intraoperative cholangiography (IOC), while 72.3% routinely performed critical safety reviews. Thirty-five percent estimated that their institution’s laparoscopic-to-open surgery conversion rate was > 1% during LC. Roughly 95% of respondents felt that surgeons should have access to a noninvasive method for evaluating extrahepatic biliary structures; 84% felt that the most advantageous characteristic of IFC is the lack of any biliary-tree incision; and 93.3% felt that IFC would have considerable educational value in surgical training programs; and 78% felt that any surgeon who performs LC could benefit.ConclusionsSurgeons who participated in our survey overwhelmingly recommended the routine use of IFC during laparoscopic cholecystectomy as a complimentary imaging technique. Prospective randomized clinical trials remain necessary to determine whether IFC reduces the incidence of bile duct injuries and other LC complications. More... »

PAGES

675-685

References to SciGraph publications

  • 2015-07-30. Accuracy of Near Infrared-Guided Surgery in Morbidly Obese Subjects Undergoing Laparoscopic Cholecystectomy in OBESITY SURGERY
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  • 2017-03-31. SAGES clinical spotlight review: intraoperative cholangiography in SURGICAL ENDOSCOPY
  • 2002-11-01. Avoidance of biliary injury during laparoscopic cholecystectomy in JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES
  • 2010-05-23. A safe laparoscopic cholecystectomy depends upon the establishment of a critical view of safety in SURGERY TODAY
  • 2017-04-17. Management of suspected common bile duct stones on cholangiogram during same-stay cholecystectomy for acute gallstone-related disease in BMC SURGERY
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  • 2014-10-03. Routine use of fluorescent incisionless cholangiography as a new imaging modality during laparoscopic cholecystectomy in SURGICAL ENDOSCOPY
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    http://scigraph.springernature.com/pub.10.1007/s00464-019-06814-x

    DOI

    http://dx.doi.org/10.1007/s00464-019-06814-x

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/31062156


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    29 schema:description BackgroundIncisionless fluorescent cholangiography (IFC) has recently been proven feasible, safe, and efficacious as an intraoperative procedure to help identify extrahepatic bile ducts during laparoscopic cholecystectomies (LC). We conducted a pilot survey of 51 surgeons attending an international conference who perform endoscopic cholecystectomies to identify their typical LC practices, and perceptions of IFC.MethodsAn international panel of ten IFC experts, all with > 500 prior IFC procedures and related research publications, convened during the 4th International Congress of Fluorescence-Guided Surgery in Boca Raton, Florida in February 2017. The panel was charged with developing questions about LC practices and experience with IFC, and perceptions regarding its advantages, barriers to use, and indications. These questions then were asked to other congress attendees during one of the didactic sessions using an online polling application. Attendees, who ranged from zero to considerable experience performing IFC, accessed the survey via their portable devices.ResultsOf the 51 survey participants, 51% were from North America; 77% identified themselves as general/minimally invasive surgeons, and roughly 60% performed under 50 cholecystectomies/year. Only 12% performed routine intraoperative cholangiography (IOC), while 72.3% routinely performed critical safety reviews. Thirty-five percent estimated that their institution’s laparoscopic-to-open surgery conversion rate was > 1% during LC. Roughly 95% of respondents felt that surgeons should have access to a noninvasive method for evaluating extrahepatic biliary structures; 84% felt that the most advantageous characteristic of IFC is the lack of any biliary-tree incision; and 93.3% felt that IFC would have considerable educational value in surgical training programs; and 78% felt that any surgeon who performs LC could benefit.ConclusionsSurgeons who participated in our survey overwhelmingly recommended the routine use of IFC during laparoscopic cholecystectomy as a complimentary imaging technique. Prospective randomized clinical trials remain necessary to determine whether IFC reduces the incidence of bile duct injuries and other LC complications.
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