Table 2.
Summary of techniques and modalities for intraoperative visualization of bile ducts
| Modality | Application | Evidence | Safety | Ease | Success rate | Time |
|---|---|---|---|---|---|---|
| Critical view of safety (CVS) | – | Worldwide consensus that CVS technique is the gold standard for performing laparoscopic cholecystectomy, but limited evidence. | – | – | 90–95% | – |
| Intraoperative cholangiography (IOC) | After dissection in Calot’s triangle | Several very large retrospective data sets report association of IOC with lower rates of BDI. | Safe (minimally invasive) | At times cumbersome | 90–95% | 15 min |
| Laparoscopic ultrasound (LUS) | Repetitively | One retrospective study reported lower rates of BDI with LUS compared to no imaging modality. Many prospective studies report higher success rates of LUS than of IOC. | Very safe (noninvasive) | Requires considerable experience | >95% | 5–10 min |
| Cholecystocholangiography (CCC) | Before dissection in Calot’s triangle | One randomized controlled trial and several retrospective studies all show inferiority of images compared to IOC. | Reasonably safe (possible added risk of gallbladder rupture) | Easy | ~80% | 5–10 min |
| Dye cholangiography | Real time | Several series describe visualizing the biliary tract but convincing images and quantitative data are lacking. | Reasonably safe (risk of dye extravasation) | Easy | ~90% | 5–10 min |
| Light cholangiography | Real time | One series in patients is reported but no images are provided. | Potentially hazardous (retrograde maneuvering of an optical fiber into CBD) | Requires endoscopy skills | Unknown | Unknown |
| Passive infrared cholangiography | Real time | One study in pigs yielding excellent images. | Safe (minimally invasive) | Unknown | Unknown | Unknown |
| Near-infrared fluorescence cholangiography (NIRF-C) | Real time | Several animal studies yielding high-quality images of the biliary tract and BDI. A few small studies in patients yielding images of limited quality. One study of 52 patients with fair results. | Safe (noninvasive when intravenous agents are used) | Easy | Unknown | Unknown |
| Hyperspectral cholangiography | Real time | Two studies in pigs report positive differentiation between gallbladder tissue and blood vessel tissue. | Very safe (noninvasive) | Easy | Unknown | Unknown |
BDI bile duct injury, CBD common bile duct