Real-time near-infrared fluorescent cholangiography could shorten operative time during robotic single-site cholecystectomy

Buchs, Nicolas ; Pugin, François ; Azagury, Dan ; Jung, Minoa ; Volonte, Francesco ; Hagen, Monika ; Morel, Philippe

In: Surgical Endoscopy, 2013, vol. 27, no. 10, p. 3897-3901

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    Summary
    Background: With the introduction of a new platform, robotic single-site cholecystectomy (RSSC) has been reported as feasible and safe for selected cases. In parallel, the development of real-time near-infrared fluorescent cholangiography using indocyanine green (ICG) has been seen as a help during the dissection, even if the data are still preliminary. The study purpose is to report our experience with ICG RSSC and compare the outcomes to standard RSSC. Methods: From February 2011 to December 2011, 44 selected patients underwent RSSC for symptomatic cholelithiasis. Among them, 23 (52.3%) were included in an experimental protocol using the ICG, and the remainder (47.7%) underwent standard RSSC. There was no randomization. The endpoints were the perioperative outcomes. This is a prospective study, approved by our local Ethics Committee. Results: There were no differences in terms of patients' characteristics, except that there were more male patients in the ICG group (47.8 vs. 9.5%; p=0.008). Regarding the surgical data, the overall operative time was shorter for the ICG group, especially for patients with a body mass index (BMI) ≤25 (−24min) but without reaching statistical significance (p=0.06). For BMI>25, no differences were observed. Otherwise, there were no differences in terms of conversion, complications, or length of stay between both groups. Conclusions: A RSSC with a real-time near-infrared fluorescent cholangiography can be performed safely. In addition, for selected patients with a low BMI, ICG could shorten the operative time during RSSC. Larger studies are still required before drawing definitive conclusions