The use of indocyanine green fluorescence imaging in preventing postoperative bile leakage of the hepaticojejunostomy in robot-assisted pancreatic surgery
Anton F. Gijsen , Roelof P.H. de Vries , Harry G.M. Vaassen , Robert H. Geelkerken , Mike S.L. Liem , Daan J. Lips
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引用次数: 0
Abstract
Background
Postoperative bile leakage (POBL) due to insufficiency of the hepaticojejunostomy (HJ) after pancreatico-duodenectomy (PD) is associated with high morbidity and mortality. The aim of this cohort study was to determine the clinical relevance of ICG in detecting and preventing POBL of the HJ in robotic minimal invasive pancreatic surgery (R-MIPS).
Methods
All consecutive robot- and ICG-assisted HJ-anastomoses between 2019 and 2022 were included. Biliary leakage was objectified with near infrared technology. Only clinically relevant POBL were considered in this study.
Results
Sixty patients who underwent a PD between 2019 and 2022 were included. In ten patients, fluorescence imaging revealed an intra-operative hepaticojejunostomy insufficiency (HJI). Five of these patients developed POBL despite revision but preventing POBL in five patients. Detection of HJI with ICG predicted POBL with a sensitivity and specificity of 41.6% and 89.6% respectively. There was a significant higher chance of developing a POBL if the hepatic duct diameter was less than 5 mm (relative risk = 4.68 (p = 0.0345)), or if an intra-operative HJI was detected (relative risk = 3.57 (p = 0.009)).
Conclusion
ICG is a simple and useful tool for detecting intra-operative bile leakage. This study shows that bile illumination with ICG in R-MIPS could prevent postoperative bile leakage.
期刊介绍:
HPB is an international forum for clinical, scientific and educational communication.
Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice.
Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice.
HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields.
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