Frequent Intraoperative Use of Fluorescence Cholangiography Is Associated With Higher Surgical Difficulty in Laparoscopic Cholecystectomy.

PURPOSE: Intraoperative indocyanine green fluorescence is useful in laparoscopic cholecystectomy (Lap-C). The objective of this study was to identify clinical situations in which fluorescence cholangiography is advantageous.

METHODS

We retrospectively reviewed intraoperative videos of 64 patients who underwent Lap-C with fluorescence cholangiography and recorded the number of times intraoperative near-infrared mode (NIR-mode) was used. The relationship between the number of times NIRF-mode was used and certain clinical variables was investigated.

RESULTS

NIR-mode was used in a single operation a median of 6 times and a maximum of 25 times. Multivariate analysis revealed that surgical difficulty score (in accordance with the Tokyo Guidelines 2018) was an independent and significant clinical factor affecting the number of times NIR-mode was used, which was significantly correlated with surgical difficulty and operation time. In the high NIR-mode group, surgical difficulty score, operative time, and blood loss were significantly higher compared with the low NIR-mode group; conversion to open surgery, bile duct injury, and postoperative complications were comparable.

CONCLUSIONS

Frequent use of fluorescence cholangiography is associated with higher surgical difficulty in Lap-C and may be helpful for avoiding misidentification of biliary anatomy.