PhD ceremony Mr. K.T. Buddingh: Assessment of the biliary tree. During gallbladder surgery

PhD ceremony: Mr. K.T. Buddingh, 12.45 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Assessment of the biliary tree. During gallbladder surgery

Promotor(s): prof. R.J. Ploeg

Faculty: Medical Sciences

Cholecystectomy, the surgical removal of the gallbladder, is a frequently performed procedure. A small percentage of operations are complicated by injury of the bile ducts. This often leads to extra surgical procedures and prolonged hospital stay. In this thesis we explore different modalities to assess the biliary tract and thus decrease the chance of bile duct injury.

Some techniques have become fully integrated in daily practice in the Netherlands, such as the ‘critical view of safety’ technique. A different technique, ‘intra-operative cholangiography’ has, however, almost disappeared. This development is worrisome as there is a great deal of evidence that cholangiography reduces the chance of bile duct injury. In other countries in the developed world cholangiography is practiced more often than in the Netherlands. We furthermore advocate that the best documentation of laparoscopic surgery would be by recording the full procedure on tape, in parallel to the ‘black box recorder’ in the aviation industry. The newest technique for assessment of the biliary tree is by ‘fluorescence cholangiography’. Hereby, a fluorescent agent is instilled in the biliary tract. During surgery, this fluorescent agent emits light that is captured by specialized camera’s and processed into images. This thesis shows that the technique is effective in pig gallbladders and that it is safe for use in patients.