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

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
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Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

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.

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Acknowledgments

We thank Prof. Dr. Fehmi Celebi and Associate Professor Fatih Altintoprak for comments that greatly improved the manuscript, also Prof. Dr. Sebiha Özkan for the review of the manuscript in terms of linguistic rules.

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of General Surgery, Faculty of Medicine, Sakarya University, Adnan Menderes Caddesi, Saglik Sokak No:193, 54100, Sakarya, Turkey

    Orhan Veli Ozkan

  2. Department of General Surgery, Research and Educational Hospital, Sakarya University, 54100, Sakarya, Turkey

    Orhan Yagmurkaya

  3. Council of Forensic Medicine, Bahçelievler, 34196, Istanbul, Turkey

    Muhammed Feyzi Sahin & Ahmet Selcuk Gurler

  4. Department of Forensic Medicine, Faculty of Medicine, Dumlupınar University, 43266, Sakarya, Turkey

    Hudaverdi Kucuker

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  1. Orhan Veli Ozkan
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  2. Orhan Yagmurkaya
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  4. Ahmet Selcuk Gurler
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  5. Hudaverdi Kucuker
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Correspondence to Orhan Veli Ozkan.

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Ozkan, O.V., Yagmurkaya, O., Sahin, M.F. et al. Visualizing biliary tracts with isosulphan blue to prevent injury during laparoscopic cholecystectomy: a preliminary cadaveric study. Surg Radiol Anat 37, 1233–1237 (2015). https://doi.org/10.1007/s00276-015-1502-z

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  • DOI: https://doi.org/10.1007/s00276-015-1502-z

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