CC BY 4.0 · Surg J (N Y) 2021; 07(01): e35-e40
DOI: 10.1055/s-0040-1721432
Original Article

Novel Use of Intraoperative Fluoroscopy in an Era of ICG for Complex Laparoscopic Cholecystectomy

1   Department of GI and Laparoscopic Surgery, Global Hospital, Mumbai, Maharashtra, India
2   Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
Sadashiv N. Chaudhari
2   Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
2   Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
› Author Affiliations
Funding All authors declare that there were no sources of funding for this study.


Background Laparoscopic cholecystectomy (LC) is increasingly being used as a first-line treatment for acute cholecystitis. Bile duct injury (BDI) remains the most feared complication of the minimally invasive approach specially in cases with an inflamed calots triangle. While use of indocyanine dye (ICG) to delineate biliary anatomy serves to reduce BDI, the high cost of the technology prohibits its use in the developing world. We propose a novel use of common bile duct (CBD) stenting preoperatively in cases of cholecystitis secondary to choledocholithiasis as a means of identification and safeguarding the CBD.

Methods A retrospective review was conducted on 22 patients of Grade 2 or Grade 3 cholecystitis who underwent an early LC at our institution. All patients were stented preoperatively and the stent was used for a much-needed tactile feedback during dissection. A c-arm with intraoperative fluoroscopy was used to identify the CBD prior to clipping of the cystic duct.

Results The gall bladder was gangrenous in all the cases while two cases had evidence of end organ damage. This innovative use of CBD stenting allowed us to correctly delineate biliary anatomy in all of the cases and we report no instances of BDI despite a severely inflamed local environment.

Conclusion This technique can become a standard of care in all teaching institutions in developing countries further enhancing the safety of cholecystectomy in gangrenous cholecystitis with a distorted biliary anatomy.

Ethics Approval

This research study was conducted retrospectively from data obtained for clinical purposes. Ethical approval was granted by the Institutional Ethics Committee.

Availability of Data and Material

All patient records were obtained from the medical records department of our hospital.

Code Availability

Not applicable.

Consent to Participate and Consent for Publication

Owing to the retrospective nature of the study and since anonymity of the patient data was ensured, a waiver of consent was granted by our Institutional Ethics Committee.

Authors' Contributions

All authors contributed to the study equally. J.G. contributed toward study conception, study design, and writing of manuscript. P.S. contributed toward study design and writing of manuscript. S.C. did the study design. A.B. contributed toward data collection, statistical analysis, and writing of manuscript. All authors read and approved the final manuscript.

Publication History

Received: 14 August 2020

Accepted: 14 October 2020

Article published online:
28 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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