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Biomedical Optics Express

Biomedical Optics Express

  • Editor: Joseph A. Izatt
  • Vol. 3, Iss. 9 — Sep. 1, 2012
  • pp: 1964–1971

Visibility enhancement of common bile duct for laparoscopic cholecystectomy by vivid fiber-optic indication: a porcine experiment trial

Hsing-Ying Lin, Chen-Han Huang, Shannon Shy, Yu-Chung Chang, Hsiang-Chen Chui, Tsung-Chih Yu, and Chih-Han Chang  »View Author Affiliations

Biomedical Optics Express, Vol. 3, Issue 9, pp. 1964-1971 (2012)

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Bile duct injury (BDI) is the most serious iatrogenic complication during laparoscopic cholecystectomy (LC) and occurs easily in inexperienced surgeons since the position of common bile duct (CBD) and its related ductal junctions are hard to precisely identify in the hepatic anatomy during surgery. BDI can be devastating, leading to chronic morbidity, high mortality, and prolonged hospitalization. In addition, it is the most frequent injury resulting in litigation and the most likely injury associated with a successful medical malpractice claim against surgeons. This study introduces a novel method for conveniently and rapidly indicating the anatomical location of CBD during LC by the direct fiber-optic illumination of 532-nm diode-pumped solid state laser through a microstructured plastic optical fiber to avoid the wrong identification of CBD and the injury from mistakenly cutting the CBD that can lead to permanent and even life threatening consequences. Six porcine were used for preliminary intra-CBD illumination experiments via laparotomy and direct duodenal incision to insert the invented CBD illumination laser catheter with nonharmful but satisfactory visual optical density.

© 2012 OSA

OCIS Codes
(170.1610) Medical optics and biotechnology : Clinical applications
(170.2680) Medical optics and biotechnology : Gastrointestinal
(170.2945) Medical optics and biotechnology : Illumination design

ToC Category:
Endoscopes, Catheters and Micro-Optics

Original Manuscript: May 24, 2012
Manuscript Accepted: July 23, 2012
Published: July 31, 2012

Hsing-Ying Lin, Chen-Han Huang, Shannon Shy, Yu-Chung Chang, Hsiang-Chen Chui, Tsung-Chih Yu, and Chih-Han Chang, "Visibility enhancement of common bile duct for laparoscopic cholecystectomy by vivid fiber-optic indication: a porcine experiment trial," Biomed. Opt. Express 3, 1964-1971 (2012)

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  1. M. C. Richardson, G. Bell, G. M. Fullarton, and West of Scotland Laparoscopic Cholecystectomy Audit Group, “Incidence and nature of bile duct injuries following laparoscopic cholecystectomy: an audit of 5913 cases,” Br. J. Surg.83(10), 1356–1360 (1996). [CrossRef] [PubMed]
  2. D. R. Fletcher, M. S. T. Hobbs, P. Tan, L. J. Valinsky, R. L. Hockey, T. J. Pikora, M. W. Knuiman, H. J. Sheiner, and A. Edis, “Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study,” Ann. Surg.229(4), 449–457 (1999). [CrossRef] [PubMed]
  3. P. R. Savassi-Rocha, S. R. Almeida, M. D. Sanches, M. A. C. Andrade, J. T. Frerreira, M. T. C. Diniz, and A. L. S. Rocha, “Iatrogenic bile duct injuries,” Surg. Endosc.17(9), 1356–1361 (2003). [CrossRef] [PubMed]
  4. B. V. MacFadyen, R. Vecchio, A. E. Ricardo, and C. R. Mathis, “Bile duct injury after laparoscopic cholecystectomy. The United States experience,” Surg. Endosc.12(4), 315–321 (1998). [CrossRef] [PubMed]
  5. J. J. Roslyn, G. S. Binns, E. F. X. Hughes, K. Saunders-Kirkwood, M. J. Zinner, and J. A. Cates, “Open cholecystectomy. A contemporary analysis of 42,474 patients,” Ann. Surg.218(2), 129–137 (1993). [CrossRef] [PubMed]
  6. S. M. Strasberg, M. Hertl, and N. J. Soper, “An analysis of the problem of biliary injury during laparoscopic cholecystectomy,” J. Am. Coll. Surg.180(1), 101–125 (1995). [PubMed]
  7. D. C. Wherry, M. R. Marohn, M. P. Malanoski, S. P. Hetz, and N. M. Rich, “An external audit of laparoscopic cholecystectomy in the steady state performed in medical treatment facilities of the Department of Defense,” Ann. Surg.224(2), 145–154 (1996). [CrossRef] [PubMed]
  8. J. A. Windsor and J. Pong, “Laparoscopic biliary injury: more than a learning curve problem,” Aust. N. Z. J. Surg.68(3), 186–189 (1998). [CrossRef] [PubMed]
  9. S. Adamsen, O. H. Hansen, P. Funch-Jensen, S. Schulze, J. G. Stage, and P. Wara, “Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series,” J. Am. Coll. Surg.184(6), 571–578 (1997). [PubMed]
  10. D. R. Flum, A. Cheadle, C. Prela, E. P. Dellinger, and L. Chan, “Bile duct injury during cholecystectomy and survival in medicare beneficiaries,” JAMA290(16), 2168–2173 (2003). [CrossRef] [PubMed]
  11. E. C. H. Lai and W. Y. Lau, “Mirizzi syndrome: history, present and future development,” ANZ J. Surg.76(4), 251–257 (2006). [CrossRef] [PubMed]
  12. N. N. Massarweh, A. Devlin, R. G. Symons, J. A. Broeckel Elrod, and D. R. Flum, “Risk tolerance and bile duct injury: surgeon characteristics, risk-taking preference, and common bile duct injuries,” J. Am. Coll. Surg.209(1), 17–24 (2009). [CrossRef] [PubMed]
  13. S. A. Ahrendt and H. A. Pitt, “Surgical therapy of iatrogenic lesions of biliary tract,” World J. Surg.25(10), 1360–1365 (2001). [CrossRef] [PubMed]
  14. J.-F. Gigot, J. Etienne, R. Aerts, E. Wibin, B. Dallemagne, F. Deweer, D. Fortunati, M. Legrand, L. Vereecken, J.-M. Doumont, P. Van Reepinghen, and C. Beguin, “The dramatic reality of biliary tract injury during laparoscopic cholecystectomy. an anonymous multicenter Belgian survey of 65 patients,” Surg. Endosc.11(12), 1171–1178 (1997). [CrossRef] [PubMed]
  15. J. Calvete, L. Sabater, B. Camps, A. Verdú, A. Gomez-Portilla, J. Martín, M. A. Torrico, B. Flor, N. Cassinello, and S. Lledó, “Bile duct injury during laparoscopic cholecystectomy: myth or reality of the learning curve?” Surg. Endosc.14(7), 608–611 (2000). [CrossRef] [PubMed]
  16. B. J. Carroll, M. Birth, and E. H. Phillips, “Common bile duct injuries during laparoscopic cholecystectomy that result in litigation,” Surg. Endosc.12(4), 310–314 (1998). [CrossRef] [PubMed]
  17. D. R. Flum, E. P. Dellinger, A. Cheadle, L. Chan, and T. Koepsell, “Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy,” JAMA289(13), 1639–1644 (2003). [CrossRef] [PubMed]
  18. D. R. Flum, T. Koepsell, P. Heagerty, M. Sinanan, and E. P. Dellinger, “Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error?” Arch. Surg.136(11), 1287–1292 (2001). [CrossRef] [PubMed]
  19. G. B. Melton, K. D. Lillemoe, J. L. Cameron, P. A. Sauter, J. Coleman, and C. J. Yeo, “Major bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life,” Ann. Surg.235(6), 888–895 (2002). [CrossRef] [PubMed]
  20. D. Boerma, E. A. J. Rauws, Y. C. A. Keulemans, J. J. G. H. Bergman, H. Obertop, K. Huibregtse, and D. J. Gouma, “Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis,” Ann. Surg.234(6), 750–757 (2001). [CrossRef] [PubMed]
  21. D. E. Moore, I. D. Feurer, M. D. Holzman, L. J. Wudel, C. Strickland, D. L. Gorden, R. Chari, J. K. Wright, and C. W. Pinson, “Long-term detrimental effect of bile duct injury on health-related quality of life,” Arch. Surg.139(5), 476–482 (2004). [CrossRef] [PubMed]
  22. W. C. Chapman, A. Halevy, L. H. Blumgart, and I. S. Benjamin, “Postcholecystectomy bile duct strictures. Management and outcome in 130 patients,” Arch. Surg.130(6), 597–604 (1995). [CrossRef] [PubMed]
  23. E. de Santibañes, V. Ardiles, A. Gadano, M. Palavecino, J. Pekolj, and M. Ciardullo, “Liver transplantation: the last measure in the treatment of bile duct injuries,” World J. Surg.32(8), 1714–1721 (2008). [CrossRef] [PubMed]
  24. E. de Santibañes, J. Pekolj, L. McCormack, J. Nefa, J. Mattera, J. Sívori, C. Bonofiglio, A. Gadano, and M. Ciardullo, “Liver transplantation for the sequelae of intra-operative bile duct injury,” HPB (Oxford)4(3), 111–115 (2002). [CrossRef] [PubMed]
  25. S. B. Archer, D. W. Brown, C. D. Smith, G. D. Branum, and J. G. Hunter, “Bile duct injury during laparoscopic cholecystectomy: results of a national survey,” Ann. Surg.234(4), 549–559 (2001). [CrossRef] [PubMed]
  26. L. Stewart and L. W. Way, “Bile duct injuries during laparoscopic cholecystectomy. Factors that influence the results of treatment,” Arch. Surg.130(10), 1123–1128, discussion 1129 (1995). [CrossRef] [PubMed]
  27. A. M. Davidoff, T. N. Pappas, E. A. Murray, D. J. Hilleren, R. D. Johnson, M. E. Baker, G. E. Newman, P. B. Cotton, and W. C. Meyers, “Mechanisms of major biliary injury during laparoscopic cholecystectomy,” Ann. Surg.215(3), 196–202 (1992). [CrossRef] [PubMed]
  28. V. Mahatharadol, “Bile duct injuries during laparoscopic cholecystectomy: an audit of 1522 cases,” Hepatogastroenterology51(55), 12–14 (2004). [PubMed]
  29. J. R. Francoeur, K. Wiseman, A. K. Buczkowski, S. W. Chung, and C. H. Scudamore, “Surgeons’ anonymous response after bile duct injury during cholecystectomy,” Am. J. Surg.185(5), 468–475 (2003). [CrossRef] [PubMed]
  30. J. Bingener-Casey, M. L. Richards, W. E. Strodel, W. H. Schwesinger, and K. R. Sirinek, “Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review,” J. Gastrointest. Surg.6(6), 800–805 (2002). [CrossRef] [PubMed]
  31. K. A. Kern, “Medicolegal analysis of bile duct injury during open cholecystectomy and abdominal surgery,” Am. J. Surg.168(3), 217–222 (1994). [CrossRef] [PubMed]
  32. B. Alkhaffaf and B. Decadt, “15 years of litigation following laparoscopic cholecystectomy in England,” Ann. Surg.251(4), 682–685 (2010). [CrossRef] [PubMed]
  33. P. Sanjay, C. Kulli, F. M. Polignano, and I. S. Tait, “Optimal surgical technique, use of intra-operative cholangiography (IOC), and management of acute gallbladder disease: the results of a nation-wide survey in the UK and Ireland,” Ann. R. Coll. Surg. Engl.92(4), 302–306 (2010). [CrossRef] [PubMed]
  34. D. E. Wenner, P. Whitwam, D. Turner, A. Chadha, and J. Degani, “Laparoscopic cholecystectomy and management of biliary tract stones in a freestanding ambulatory surgery center,” JSLS10(1), 47–51 (2006). [PubMed]
  35. S. Rojas-Ortega, D. Arizpe-Bravo, E. R. Marín López, R. Cesin-Sánchez, G. R. S. Roman, and C. Gómez, “Transcystic common bile duct exploration in the management of patients with choledocholithiasis,” J. Gastrointest. Surg.7(4), 492–496 (2003). [CrossRef] [PubMed]
  36. E. Kullman, K. Borch, E. Lindström, J. Svanvik, and B. Anderberg, “Management of bile duct stones in the era of laparoscopic cholecystectomy: appraisal of routine operative cholangiography and endoscopic treatment,” Eur. J. Surg.162(11), 873–880 (1996). [PubMed]
  37. A. Nickkholgh, S. Soltaniyekta, and H. Kalbasi, “Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy,” Surg. Endosc.20(6), 868–874 (2006). [CrossRef] [PubMed]
  38. N. J. Soper and L. M. Brunt, “The case for routine operative cholangiography during laparoscopic cholecystectomy,” Surg. Clin. North Am.74(4), 953–959 (1994). [PubMed]
  39. M. Suzuki, S. Akaishi, T. Rikiyama, T. Naitoh, M. M. Rahman, and S. Matsuno, “Laparoscopic cholecystectomy, Calot’s triangle, and variations in cystic arterial supply,” Surg. Endosc.14(2), 141–144 (2000). [PubMed]
  40. A. R. Wijsmuller, M. Leegwater, L. Tseng, H. J. Smaal, G. J. Kleinrensink, and J. F. Lange, “Optimizing the critical view of safety in laparoscopic cholecystectomy by clipping and transecting the cystic artery before the cystic duct,” Br. J. Surg.94(4), 473–474 (2007). [CrossRef] [PubMed]
  41. G. Honda, T. Iwanaga, M. Kurata, F. Watanabe, H. Satoh, and K. Iwasaki, “The critical view of safety in laparoscopic cholecystectomy is optimized by exposing the inner layer of the subserosal layer,” J. Hepatobiliary Pancreat. Surg.16(4), 445–449 (2009). [CrossRef] [PubMed]
  42. S. M. Strasberg, “Avoidance of biliary injury during laparoscopic cholecystectomy,” J. Hepatobiliary Pancreat. Surg.9(5), 543–547 (2002). [CrossRef] [PubMed]
  43. H. Tokumura, A. Umezawa, H. Cao, N. Sakamoto, Y. Imaoka, A. Ouchi, and K. Yamamoto, “Laparoscopic management of common bile duct stones: transcystic approach and choledochotomy,” J. Hepatobiliary Pancreat. Surg.9(2), 206–212 (2002). [CrossRef] [PubMed]
  44. J. L. Figueiredo, C. Siegel, M. Nahrendorf, and R. Weissleder, “Intraoperative near-infrared fluorescent cholangiography (NIRFC) in mouse models of bile duct injury,” World J. Surg.34(2), 336–343 (2010). [CrossRef] [PubMed]
  45. T. Ishizawa, Y. Bandai, M. Ijichi, J. Kaneko, K. Hasegawa, and N. Kokudo, “Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy,” Br. J. Surg.97(9), 1369–1377 (2010). [CrossRef] [PubMed]
  46. T. Ishizawa, Y. Bandai, and N. Kokudo, “Fluorescent cholangiography using indocyanine green for laparoscopic cholecystectomy: an initial experience,” Arch. Surg.144(4), 381–382 (2009). [CrossRef] [PubMed]
  47. G. Elert, ed., “Wavelength of maximum human visual sensitivity,” http://hypertextbook.com/facts/2007/SusanZhao.shtml .

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