Intraoperative fluorescent cholangiography using indocyanine green: a biliary road map for safe surgery.

F T i m k c 8 nlike blood vessels, the biliary tract lies in the Glissonian heath and is buried in the perivascular connective tissue, o it is difficult to clearly visualize and isolate it during epatobiliary surgery. Intraoperative cholangiography IOC), which was originally introduced by Mirizzi in 937, has been widely used to delineate the biliary tract natomy in this setting. For example, routine IOC was ecently recommended during cholecystectomy to prevent ile duct injury. IOC is also considered an essential proedure during donor hepatectomy because it enables the ile duct to be divided at the appropriate level to ensure ider and fewer residual orifices. But conventional raiographic IOC is disadvantageous in that it exposes the atient and the medical staff to radiation and usually reuires a large and expensive C-arm fluoroscopy machine nd the additional human resources involved. Recently, intraoperative angiography using a fluorescent maging technique with IV injection of indocyanine green ICG) has been used to assess coronary artery bypass graft atency. This technique is based on the principle that CG binds to plasma proteins and that protein-bound ICG mits light with a peak wavelength of about 830 nm when lluminated with near-infrared light. Because human ile also contains plasma proteins that bind with ICG, we ypothesized that fluorescent images of the biliary tract ould be obtained with intrabiliary injection of ICG. We lso hypothesized that IV injection of ICG would provide luorescent images of the biliary tract without necessitating