Cleveland Clinic Florida researchers have demonstrated a major advancement in gallbladder removal surgery using a novel intraoperative imaging technique called near-infrared fluorescent cholangiography (NIFC). The technique reduces complication rates and improves patient safety in gallbladder removal surgeries, one of the most common surgeries performed in the United States.

“Complications associated with gallbladder removal will be significantly decreased with near-infrared fluorescent cholangiography,” said Raul Rosenthal, M.D., Chairman of the Department of General Surgery at Cleveland Clinic Florida, who led the study investigating the use of NIFC. “I am confident that this intraoperative imaging modality will change how cholecystectomies are being performed in the United States and around the world for years to come, making surgery safer for patients.”

The gallbladder is a small digestive organ that stores bile produced in the liver before it is released into the small intestine to help digest fat. A cholecystectomy, the removal of the gallbladder, is performed more than 750,000 times a year in the United States to treat gallstones, gallbladder inflammation and infections, among other conditions.

Use of NIFC to improve patient safety is particularly significant as the number of gallbladder surgeries in the United States is expected to rise as obesity rates continue to climb. Obesity affects the functionality of the gallbladder and increases the probability of developing gallbladder disease.

Today most gallbladder surgeries are performed laparoscopically, through small incisions in the abdomen, which decreases morbidity, reduces pain, shortens hospital stays, and accelerates recovery. Despite these advantages to open surgery, the inability to directly feel the small structures connecting the gallbladder to other organs can hinder the surgeon’s ability to clearly differentiate between important anatomical structures.

According to Dr. Rosenthal, one of the most feared complications of laparoscopic gallbladder removal is a nicking of the attached biliary tree, which consists of the bile duct and vessels leading to it. These structures are millimeters wide and especially hard to see laparoscopically due to the lost tactile perception. The rate of bile duct injury nationally has increased from approximately 0.2 percent with open cholecystectomy to 0.5 percent for laparoscopic cholecystectomy. A major bile duct injury can be life threatening and ultimately decrease the patient’s quality of life and increase the cost of care.

With near-infrared fluorescent cholangiography, visibility is enhanced by illuminating an injectable dye with infrared light as it passes through the gallbladder and surrounding vessels during a laparoscopic cholecystectomy. This allows surgeons to better see critical anatomical structures and expedite their decision making, decreasing the potential for surgical complications.

Dr. Rosenthal led a multicenter, international clinical trial comparing NIFC to standard white light imaging in visualizing and identifying the main biliary and hepatic structures during laparoscopic cholecystectomy. The findings, which demonstrated NIFC to be superior, were published in January in the Annals of Surgery, the world's most highly referenced surgery journal.

The results of the multicenter trial also were presented on Saturday, February 16, 2019, at the 6th International Conference on Fluorescent Guided Imaging Surgery during the 18th Annual Surgery of the Foregut Symposium hosted by the Cleveland Clinic Digestive Disease and Surgery Institute in Fort Lauderdale, Fla.

NIFC is an alternative to conventional white light imaging, called intraoperative radiologic cholangiography (IOC), which is an invasive and time-consuming imaging modality that has not demonstrated a decrease in the incidence of bile duct injuries or an improvement in the visualization of vessels. In addition to being less expensive than IOC, costing on average $14 versus $778, NIFC is faster, incisionless, and requires no radiation exposure.

About Cleveland Clinic Florida
Cleveland Clinic Florida is a nonprofit, multi-specialty, academic medical center that integrates clinical and hospital care with research and education. With locations in Weston, Fort Lauderdale, Coral Springs, Parkland, West Palm Beach, Wellington, Palm Beach Gardens, Stuart, Port St. Lucie and Indian River, Cleveland Clinic Florida has more than 250 physicians with expertise in 55 specialties. The medical campus is fully integrated and includes diagnostic centers, outpatient surgery and a 24-hour emergency department located in the state-of-the-art hospital. Cleveland Clinic Florida ranked #1 among the best hospitals in the Miami-Fort Lauderdale metro area and fourth in Florida in US News & World Report’s 2018-2019 ranking of Best Hospitals metro area rankings. Cleveland Clinic Florida is an integral part of Cleveland Clinic in Ohio, where providing outstanding patient care is based upon the principles of cooperation, compassion and innovation. Physicians at Cleveland Clinic are experts in the treatment of complex conditions that are difficult to diagnose. For more information about Cleveland Clinic Florida, visit www.clevelandclinicflorida.org. Follow us on Twitter and Facebook.