Table 1.
Evidence on the different modalities for intraoperative assessment of the biliary tree
| Primary author | No. of patients | Study description | Outcome |
|---|---|---|---|
| CVS—patient series of LCs using the CVS | |||
| Rawlings [19] | 54 | All patients (suffering from biliary colic) underwent single-port LC using the CVS technique. | CVS in all patients; |
| 0 BDI, 0 bile leaks | |||
| Sanjay [18] | 447 | All patients (acute pathology) underwent LC using the CVS technique. | CVS achieved in 388 (87%); |
| 0 BDI, 0 bile leaks | |||
| Avgerinos [16] | 1,046 | All patients underwent LC using the CVS technique. | CVS achieved in 998 (95%); |
| 0 BDI, 5 bile leaks (0.5%) | |||
| Yegiyants [17] | 3,046 | Administrative data of an institution in which CVS was standard. Injuries requiring surgical repair were identified. | CVS percentage not assessed; |
| 1 BDI (0.03%), bile leaks not assessed | |||
| IOC—studies > 10,000 patients on the association between IOC and BDI | |||
| Z’graggen [34] | 10,174 | 1992–1995; analysis of LCs in a prospective database for which numerous Swiss institutions provide data (SALTS). | OR for BDI using IOC = 0.97 (95% CI 0.44–2.18), unadjusted for confounders |
| Flum [32] | 30,630 | 1991–1998; Washington State Hospital Discharge Database searched for CBD repair codes <90 days after LC. | OR for BDI using IOC = 0.63 (95% CI 0.40–0.90), adjusted for confounders |
| Hobbs [30]a | 33,309 | 1988–1998; Western Australia Data Linkage System was searched in different ways for patients with complications. Medical files of these patients were assessed in detail. | OR for BDI using IOC = 0.68 (95% CI 0.42–1.03), adjusted for confounders |
| Flum [31] | 1,570,361 | 1992–1999; US Medicare data was searched for codes for CBD repair within 1 year after cholecystectomy. | OR for BDI using IOC = 0.58 (95% CI 0.44–0.72), adjusted for confounders |
| Waage [33] | 152,776 | 1987–2001; Swedish Inpatient Registry searched for codes for CBD repair within 1 year after cholecystectomy. | OR for BDI using IOC = 0.75 (95% CI 0.59–0.92), adjusted for confounders |
| Giger [35]b | 31,838 | 1995–2005; analysis of LCs in a prospective database for which numerous Swiss institutions provide data (SALTS). | OR for BDI using IOC = 1.14 (95% CI 0.76–1.70), unadjusted for confounders |
| LUS—patient studies on LUS during LC | |||
| Machi [44] | 2,159 | Review of 12 studies (from before 1999) comparing LUS to IOC during LC. | Success of LUS and IOC 88-100%; BDI not assessed |
| Catheline [45] | 600 | All patients underwent LCs with LUS, 498 also underwent IOC. | LUS and IOC equal success; LUS faster (10 vs. 18 min, P = 0.001) BDI not reported |
| Kimura [49] | 183 | All patients underwent LCs with LUS and IOC. | LUS success 95%; IOC success 96%; 0 BDI; 1 bile leak after choledochotomy |
| Tranter [54] | 367 | All patients underwent LC with LUS. | LUS success 99%; BDI not reported |
| Biffl [46] | 844 | Nonrandomized comparison between LC with LUS (n = 248) and without LUS (594). | Without LUS: 11 BDI (1.9%); routine LUS: 0 BDI (P = 0.04) |
| Catheline [47] | 900 | All patients underwent LCs with LUS and IOC. | LUS success 100%; IOC success 85%; BDI not reported |
| Tranter [55] | 135 | All patients underwent LCs with LUS and IOC. | LUS success 97%, IOC success 90%; BDI not reported |
| Onders [52] | 256 | Description of one surgeon’s experience with LUS. | Increase in use of LUS from 29% in 2001 to 77% in 2004; 0 BDI |
| Machi [50] | 200 | All patients underwent LC with LUS. | LUS success in 97%; 0 BDI, 0 bile leaks |
| Perry [53] | 236 | All patients underwent LC with LUS. | LUS success in 95%; 0 BDI; 0 bile leaks |
| Hakamada [48] | 644 | Comparison of outcome before (n = 368) and after (n = 276) introduction of routine LUS. | Without LUS: 4 BDI (1.1%); routine LUS: 0 BDI (P = 0.08) |
| Machi [51] | 1,381 | Prospective multicenter series of LC with LUS. | LUS success 98%; 0 BDI; 3 leaks (0.2%) |
| CCC—patient studies on CCC during LC | |||
| Wills [58] | 76 | Randomized controlled trial between IOC (n = 36) and CCC (n = 40) during LC. | IOC success in 100%, CCC in 72% (P < 0.001); CCC images of poor quality |
| Daoud [59] | 325 | Nonrandomized comparison between IOC (n = 35) and CCC (n = 290). | IOC success 83%, CCC success 86% |
| Glattli [60] | 69 | Nonrandomized comparison between IOC (n = 38) and CCC (n = 31). | IOC success 92%, CCC success 48%; CCC images of inferior quality |
| Fox [61] | 113 | All patients underwent LC with CCC. | CCC was successful in 81% |
| Koksal [62] | 40 | All patients underwent LC with CCC. | CCC was successful in 90% |
| Moont [63] | 97 | All patients underwent LC with CCC. | CCC was successful in 85% |
| Young [64] | 194 | All patients underwent LC with CCC. | CCC was successful in 81% |
| Holzman [65] | 60 | Patients underwent “partial CCC” with the Kumar clamp. | Kumar CCC was successful in 83% |
| Kumar [66] | 50 | Patients underwent “partial CCC” with the Kumar clamp. | Kumar CCC was successful in 98% |
| Dye cholangiography—patient series on dye cholangiography during LC | |||
| Pertsemlidis [67] | 18 | Indocyanine green (ICG) was intravenously administered to patients undergoing LC. | Cystic duct and CBD colored green in all patients. No images provided |
| Sari [68] | 46 | Blue dye was injected into the gallbladder during LC. | Cystic duct and CBD colored blue in 43/46 patients |
| Xu [69] | 20 | Blue dye was injected into the gallbladder during LC. | Extrahepatic bile ducts colored blue in 18/20 patients. No images provided |
| Light cholangiography—patient series | |||
| Xu [69] | 16 | Optical fiber led into the CBD with a duodenoscope during LC. CBD cannulation successful in 13/16 patients. | CBD visualized in 13 cases, cystic duct only in 4 cases. No images provided |
| Passive infrared cholangiography—animal study | |||
| Liu [70] | 6 pigs | Room temperature saline was infused into the biliary tract. Images were taken with an infrared camera. | Infrared images correlated well with IOC. Artificial stones and BDI detected |
| Near-infrared cholangiography (NIRF-C)—patient studies on NIRF-C | |||
| Mitsuhashi [73] | 5 | Open cholecystectomy after intravenous infusion of ICG. A NIRF camera system was used to capture images. | Fluorescence observed in the liver, gallbladder, and bile ducts of all patients |
| Ishizawa [71] | 1 | First laparoscopic experience with NIRF-C during cholecystectomy. | Fluorescence observed in cystic duct and CBD |
| Ishizawa [74] | 10 | Open cholecystectomy after intravenous infusion of ICG. A NIRF camera system was used to capture images. | Cystic duct and CBD were identified in 9/10 patients using NIRF-C |
| Aoki [75] | 14 | LC after intravenous administration of ICG. | CBD-cystic duct junction identified in 10/14 patients |
| Tagaya [76] | 12 | LC after intravenous ICG. Hepatoduodenal ligament was compressed with plastic device for improved exposure. | The CBD-cystic duct junction was identified in all patients |
| Ishizawa [86] | 52 | LC after intravenous ICG. | CBD-cystic duct junction identified in 50/52 patients |
| Hyperspectral cholangiography—animal studies | |||
| Zuzak [82] | 1 pig | A laparoscopic near-infrared, hyperspectral imaging system was used to assess bile duct anatomy in a pig. | Bile ducts, arteries, and veins all have unique reflectance spectra |
| Livingston [81] | 8 pigs | Characteristics of different types of tissue were assessed using a laparoscopic hyperspectral imaging system. | Bile ducts, arteries, and veins all have unique reflectance spectra |
LC laparoscopic cholecystectomy, CVS critical view of safety, BDI bile duct injury, IOC intraoperative cholangiography, LUS laparoscopic ultrasound, CCC cholecystocholangiography, NIRF-C near-infrared fluorescence cholangiography, CBD common bile duct, ICG indocyanine green, OR odds ratio
aIncludes data set of Fletcher et al. [84]
bIncludes data set of Krahenbuhl et al. [85]