Cleveland Clinic Florida Researchers Discover Breakthrough in Gallbladder Removal Surgery

Raul Rosenthal, M.D., Chairman of the Department of General Surgery at Cleveland Clinic Florida shows an image of the near-infrared fluorescent cholangiography (NIFC), an imaging technique Cleveland Clinic Florida is using to reduce the risk of complications for gallbladder removal surgery.

Gallbladder removal surgery is one of the most common surgeries performed in the United States. In fact, more than 750,000 cholecystectomies are performed each year. A new technique for gallbladder removal surgery discovered by researchers at Weston-based Cleveland Clinic Florida is reducing complication rates and improving patient safety. 

Raul Rosenthal, M.D., Chairman of the Department of General Surgery at Cleveland Clinic Florida, led the study. By using a novel intraoperative imaging technique called near-infrared fluorescent cholangiography (NIFC), doctors are able to dramatically reduce the risk of complications associated with gallbladder removal.

“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,” states Dr. Rosenthal. 

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. As obesity rates continue to climb in this country, the number of gallbladder surgeries are expected to increase because obesity affects the functionality of the gallbladder and increases the probability of developing gallbladder disease. 

Most gallbladder surgeries today are performed laparoscopically, through a tiny incision in the abdomen. While this method decreases morbidity, reduces pain, and shortens hospital stays when compared to open surgery, laparoscopic surgery does have challenges. 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 when performing laparoscopic gallbladder removal surgery is nicking the bile duct and the vessels leading to it. Just millimeters wide, these structures are especially difficult to see laparoscopically due to the lost tactile perception. A major bile duct injury can be life-threatening and could decrease a patient’s quality of life and increase the cost of care. 

Dr. Rosenthal and his fellow researchers discovered that surgeons could better see the anatomical structures when using near-infrared fluorescent cholangiography (NIFC). It enhances visibility by injecting an illuminating dye with infrared light as it passes through the gallbladder and surrounding vessels. Not only does NIFC provide better visualization, which leads to better surgical outcomes, it is less expense, faster, incisionless and requires no radiation exposure. 

Their clinical trial compared NIFC to standard white light imaging. The findings, which demonstrated NIFC to be superior, were published in the Annals of Surgery, the world’s most highly referenced surgery journal, and presented at the 6th International Conference on Fluorescent Guided Imaging Surgery hosted by the Cleveland Clinic Digestive Disease and Surgery Institute.