Fluorescentiebeeldvorming van de galwegen tijdens kijkoperaties van de galblaas.

Laparoscopic cholecystectomy is one of the most commonly performed endoscopic procedures in gastrointestinal surgery. Bile duct injury (BDI) during this surgery is rare but constitutes a serious complication (0.3-0.7%). Misidentification of biliary anatomy during laparoscopic cholecystectomy appears to be the largest cause of BDI. Intraoperative cholangiography (IOC) is advised to reduce the risk of BDI. However, this imaging technique is only used selectively. The process takes time, radiation exposure is involved and additional equipment and manpower for the proceedings are required. Moreover, worldwide consensus about the implementation of IOC is lacking.

Fluorescence cholangiography with preoperative indocyanin green (ICG) administration is a promising new technique for easier intraoperative visualization of the biliary anatomy and thereby it could improve the outcome – safety and efficiency – of laparoscopic cholecystectomy.



Standard laparoscopic cholecystectomy will be performed, after preoperative intravenous administration of the near-infrared fluorescence dye indocyanine green. Using a modified laparoscopic device (for both conventional and fluorescence imaging) the extra-hepatic bile ducts will be visualized non-invasively.

12-09-2012: Additional intervention/observation in the last 20 patients: Simultaneous fluorescence imaging of the arterial anatomy at establishment of critical view of safety; after repeat ICG administration.

Improved and earlier identification of extra-hepatic bile ducts by intraoperative fluorescence imaging.

Primary and secondary outcomes will be assessed during (and after) surgical procedure.

Standard laparoscopic cholecystectomy will be performed, after preoperative intravenous administration of the near-infrared fluorescence dye indocyanine green. Using a modified laparoscopic device (for both white light, and ICG imaging) the extra-hepatic bile ducts will be visualized non-invasively.

12-09-2012: Addition:
Repeat intravenous ICG injection at establishment of critical view of safety for simultaneous fluorescence imaging of bile ducts and arterial anatomy.