Evaluation of the Effectiveness of Fluorescent Visualization of Bile Ducts Using Fluorescein and Ultraviolet A at Laparoscopic Cholecystectomy

摘要

Background. This work studied the diagnostic effectiveness of a new technology and device to augment visualization of bile ducts at laparoscopic cholecystectomy. It depends on excitation of fluorescein in bile by ultraviolet light to get green fluorescent light emanating from these ducts. Methods. Forty laparoscopic cholecystectomy patients received fluorescein sodium injections either in the gallbladder or intravenously, followed by exposure of the expected bile ducts area to ultraviolet light that was delivered by a specially designed device. Neutral observing surgeons were asked to judge whether or not they could see fluorescent bile ducts early in the operation before they were displayed by dissection. Accordingly, specificity, sensitivity, likelihood ratios, and predictive values of the technique were calculated. Results. Fluorescent bile ducts were seen at an earlier stage than their detection by dissection in 33 out of 40 operations. The technique had 100% specificity, 82.5% sensitivity, 0.18 negative likelihood ratio, 100% positive predictive value, and 85.11% negative predictive value. There were no complications related to the technique. Conclusions. The developing ultraviolet/fluorescein technique is helpful in early localization of bile ducts at laparoscopic cholecystectomy. When fluorescence is detected in the field, the technique can be completely relied on to denote the position of bile ducts. In a few cases fluorescence is not detected. Here further development of the device is the need to improve its sensitivity. Otherwise, the technique is quite simple and safe.