A new surgical technique and intraoperative flourescent molecular imaging for biliary reconstruction

Abstract

Up to date, many surgical techniques have been described for biliary reconstruction. The aim of this study is to try a new surgical technique for biliary reconstruction and also to show whether intraoperative fluorescent molecular imaging (IFMI) is effective to evaluate the perfusion of the new biliary conduit. Two adult pigs were operated. Cholecystectomy and removal of the extrahepatic biliary tract were performed by robotic surgery. A duodenal conduit was created from the duodenum by open surgery. The distal end of the conduit was sutured to portohepatis by end-to-end anastomosis. The perfusion of the conduit was evaluated by photo-dynamic eye. Although the viability of both of the duodenal conduits were macroscopically evaluated as normal, it was screened by IFMI that the middle and distal parts of the conduit were not well-vascularized and that only the base portion of the conduit had sufficient blood supply. As a result, IFMI is a good intraoperative diagnostic tool for showing tissue viability. This new technique may not be used for biliary reconstruction as described here. However, the development of alternative techniques to increase the viability of the conduit may enable the use of this technique successfully. 

Keywords

• Biliary conduit
• Biliary atresia
• Choledochal cyst
• Fluorescent molecular imaging
• Pig