Visualizing biliary tracts with isosulphan blue to prevent injury during laparoscopic cholecystectomy: a preliminary cadaveric study

• Published in: Surgical and radiologic anatomy (English ed.) Vol. 37; no. 10; pp. 1233 - 1237
• Main Authors: Ozkan, Orhan Veli, Yagmurkaya, Orhan, Sahin, Muhammed Feyzi, Gurler, Ahmet Selcuk, Kucuker, Hudaverdi
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-12-2015; Springer Nature B.V
• Subjects: Adult; Aged; Anatomic Bases of Medical; Anatomy; Bile; Biliary Tract - anatomy & histology; Cadaver; Cholecystectomy, Laparoscopic; Coloring Agents; Female; Humans; Imaging; Injuries; Laparoscopy; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Radiological and Surgical Techniques; Radiology; Rosaniline Dyes; Studies; Surgery; Young Adult; Bile duct injury prevention; Laparoscopic cholecystectomy complications; Isosulphan blue injection technique
• ISSN: 0930-1038; 1279-8517
• DOI: 10.1007/s00276-015-1502-z

Background
Bile duct injury (BDI) as a complication of laparoscopic cholecystectomy may result in biliary cirrhosis with a high morbidity–mortality rate. Recurrent invasive procedures may be required for the optimum management. The most frequent causative factor in BDI is anatomical misidentification, particularly by inexperienced surgeons. Direct coloration of the cystic duct, bile duct, and gallbladder may decrease biliary tract injury.
Methods
This study was conducted during 10 standard, fresh cadaver autopsies at the Council of Forensic Medicine, Istanbul. Following needle puncture of the gallbladder fundus and aspiration of the bile content, identical quantities of isosulphan blue were injected into the gallbladder to visualize the biliary tract.
Results
Of the ten fresh cadavers, three were males and seven were females; the mean age at death was 43 years (range 22–76 years). Successful visualization of the colored biliary tract, encompassing the gallbladder, cystic duct, and bile duct, was achieved in all of the cadavers.
Conclusions
Visualization of the biliary tract may reduce the risk associated with dissection of Calot’s triangle. Surgical BDI risk following anatomical misidentification could be reduced by intraoperative injection of isosulphan blue; further studies are required to validate the clinical utility of this technique.