Fibre Illumination of the Common Bile Duct

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Working with light and optics is difficult, especially when you want to use them around patients. Journals are full of papers describing intricate techniques which have been shown to work in the lab, but which would be difficult to implement in real clinical practice. On the other hand, we occasionally see some techniques which appear simple and perhaps even obvious, but which have the potential for immediate and low-cost clinical translation. One candidate for this second category is the idea of using fibre optic illumination to aid identification of the common bile duct (CBD) during laparoscopic surgery.

Two papers have recently appeared on this topic, the first in 2010 from a group based in Hangzhou (China)1 and a second in 2012 from authors based in Taiwan2. (The second paper fails to reference the earlier one, which doesn’t reflect particularly well on either the authors or the reviewers!) Both groups focused on a procedure called laparoscopic cholecystectomy – removal of the gall bladder using keyhole surgery. The benefits of performing this procedure through laparoscopy, as opposed to open surgery, are fairly obvious – essentially it leads to a faster recovery by the patient. But there are also some downsides, particularly an increased rate of accidental damage to the common bile duct (CBD).

The idea is to use fibre optics to send light into the CBD so that it can easily be identified by the surgeon. The Hangzhou authors didn’t go into details about the fibre and laser they used, preferring to focus on the medical details. The Taiwanese Group used a picosecond laser to etch a series of grooves into the cladding along a 10 cm portion of the fibre, creating something akin to a miniaturised glow stick. Illumination was provided by a 50 mW, 532 nm (green) laser, presumably chosen to match the peak of the eye’s sensitivity. The Hangzhou paper reported a small clinical trial with sixteen patients, while the Taiwan Group merely used a porcine model, but both reported an increase in visibility of the CBD.

Whether or not this technique will ever be widely adopted is an open question, and one which only surgeons are qualified to answer. It introduces additional complexity to the procedure, which can only be justified if there is a significant benefit – something which will be hard to show when incidence rates of CBD damage are so low to begin with.

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