Extrahepatic biliary tract visualization using near-infrared fluorescence imaging with indocyanine green: optimization of dose and dosing time
AbstractBackgroundThe dose and dosing time of indocyanine green (ICG) vary among fluorescence cholangiography (FC) studies. The purpose of this prospective, randomized, exploratory clinical trial was to optimize the dose and dosing time of ICG.MethodsPubMed was searched to determine the optimal dose. To optimize the dosing time of ICG, a clinical trial was designed with two parts. The first part included patients with T tubes for more than 1 month. After the patient was injected with ICG, bile was collected at 10 time points to explore the change and trends of bile fluorescence intensity (FI). In addition, the results of the first experiment were used to setup a randomized controlled trial (RCT) that aimed to find the optimal dosing t iming for ICG injections for laparoscopic cholecystectomy (LC). During surgery, imaging data were collected for analysis.ResultsAfter performing a systematic review, the ICG injection dose for each patient in the clinical trial was 10 mg. Five patients were included in the first part of the study. Bile collected 8 h after ICG injection had a higher FI than bile collected at other time points (p
ConclusionsLCBDE + LC and IO-ERCP + LC have similar efficacy and safety in terms of technical success, morbidity, major morbidity, and conversion rate. However, LCBDE + LC is associated with a higher biliary leak rate, lower postoperative pancreatitis rate, and higher rate of retained stones.
This study aims to examine nationwide trends in the surgical management of acute cholecystitis, as well as their impact on clinical outcomes during pregnancy.MethodsThe National Inpatient Sample was queried for all pregnant women diagnosed with acute cholecystitis between January 2003 and September 2015. After applying appropriate weights, multivariate regression analysis adjusted for patient- and hospital-level characteristics and quantified the impact of discharge year (2003–2007 versus 2008–2015) on cholecystectomy rates and timing of surgery. Multivariate regression analysis was also used to examine t...
Background: We have designed a new gasless laparoscopic operation field formation (LOFF) device for cholecystectomy which was successfully tested on animal model. The goal of this study is to investigate the feasibility, safety and effectiveness of this LOFF device on patients undergoing cholecystectomy. Methods: Patients with cholecystolithiasis or gallbladder polyps who underwent single port cholecystectomy from June 2015 to May 2016 were retrospectively reviewed. Either the LOFF-assisted laparoendoscopic single-port surgery (LESS) (LOFF-LESS) or the traditional LESS was performed. Operation time, intraoperative ble...
ConclusionsOur study of published trials indicates that using low, as opposed to standard, IAP during laparoscopic cholecystectomy may reduce patients ’ post-operative pain, including shoulder pain, and length of hospital stay. Heterogeneity in the pooled estimates and high risk of bias of the included trials suggest the need for high-quality, adequately powered RCTs to confirm these findings.
EUS-guided gallbladder (EUS-GBD) is an effective and safe alternative to percutaneous drainage (PT-GBD) for acute cholecystitis. The procedure has been shown by meta-analysis to be associated with lower rates of post-procedure adverse events, shorter hospital stays, and fewer reinterventions and readmissions. However, how the procedure compares to laparoscopic cholecystectomy is unknown. The aim of the current study is to compare the long-term outcomes of EUS-GBD with laparoscopic cholecystectomy (LC) for acute cholecystitis using propensity score matching.
ConclusionLaparoscopic management of type II Mirizzi syndrome is feasible and safe when performed by experienced laparoscopic foregut surgeons. Laparoscopy and choledochoscopy can be combined with novel approaches and techniques to increase the likelihood of treatment success.
ConclusionsThe present study is the first to formalize a reproducible method for objective video reporting of CVS in LC. Minute-long video clips provide information on CVS and binary assessment yields a higher inter-rater agreement than previously used methods. These results offer an easy-to-implement strategy for objective video reporting of CVS, which could be used for quality auditing, scientific communication, and development of deep learning models for intraoperative guidance.
This study analyzed the increased costs of RAS in common surgical procedures using the National Inpatient Sample.MethodsRetrospective analysis of the 2012 –2014 Healthcare Cost and Utilization Project-NIS was performed for the following laparoscopic/robotic procedures: cholecystectomy, ventral hernia repair, right and left hemicolectomy, sigmoidectomy, abdominoperineal resection, and total abdominal hysterectomy (TAH). Patients with additional concu rrent procedures were excluded. Costs were compared between the laparoscopic procedures and their RAS counterparts. Total costs and charges for cholecystectomy (the most ...
ConclusionsPre-ERCP+LC is associated with a higher CBD stone clearance rate, lower postoperative bile leakage rate, and higher rate of pancreatitis. LCBDE+LC might help to shorten the hospital stay. Further studies on this topic are recommended.
CONCLUSION: Treatment of cystic duct leak with BDBS is highly successful and as safe as traditional treatment with PS. The most obvious benefit of BDBS is that it avoids stent removal. The lower drain output after ERC with a trend for fewer unplanned interventions may indicate more efficient leak resolution with the large bore BDBS. PMID: 30394150 [PubMed - as supplied by publisher]