Bioluminescent Cholangiography - PowerPoint PPT Presentation

1 / 35
About This Presentation
Title:

Bioluminescent Cholangiography

Description:

... other patients every year, Katherine Adams learned that a commonly performed ... MD, Dept. Surgery ELMC, Bruce Bryan MD, BioLume, Randall B. Murphy PhD ... – PowerPoint PPT presentation

Number of Views:151
Avg rating:3.0/5.0
Slides: 36
Provided by: biol7
Category:

less

Transcript and Presenter's Notes

Title: Bioluminescent Cholangiography


1
Bioluminescent Cholangiography
  • Enhancing Patient Safety

2
Background
  • 750,000 patients undergo laparoscopic
    cholecystectomy/year USA
  • Increased rate of common bile duct injury in
    laparoscopic vs. traditional open operation well
    documented
  • Most significant injury occurs when surgeon
    misidentifies CBD as cystic duct and cuts this
    structure

3
Bile duct injury
  • Strasberg Classification

4
Bile duct injury
  • Strasberg Classification

5
Bile duct injury
  • Strasberg Classification

6
Bile duct injury
  • Strasberg Classification

7
  • A Quick X-Ray Could Prevent Surgical Error
  • BY DAVID ARMSTRONG
  • Like thousands of other patients every year,
    Katherine Adams learned that a commonly performed
    surgery to remove the gallbladder can carry
    serious risk.
  • The 48-year-old Illinois woman's bile duct was
    severed during the operation, a mistake that
    experts say happens far too often and can lead to
    serious complications and death. It's also one of
    the biggest causes of surgical malpractice
    claims Ms. Adams herself won a judgment of more
    than half a million dollars against her surgeon
    and the hospital.
  • Now, mounting evidence suggests the hazard could
    often be avoided if doctors performed a
    relatively simple X-ray procedure to ...

8
  • A Quick X-Ray Could Prevent Surgical Error
  • Doctors Split Over Procedure To Prevent Common
    Injury In Gallbladder Removal . Lawrence Way, a
    surgeon at the University of California San
    Francisco who is an expert in repairing bile-duct
    injuries, said broader use of an X-ray procedure
    called an intraoperative cholangiogram that maps
    out the ducts before surgery could avoid
    accidental severing of the duct during surgery if
    "adopted as a routine part of most surgeons'
    practices." Dr. Way said the X-rays are not used
    because they're expensive and hundreds of
    cholangiograms would have to be performed to
    avoid one bile-duct injury.

9
Malpractice Insurance
10
Malpractice Insurance
11
Cholangiography
  • Advantages
  • Cholangiography is proven to lower the rate of
    CBD injury
  • Cholangiography gives information about surgical
    anatomy (and stones)

12
(No Transcript)
13
Cholangiography
  • Disadvantages
  • Time consuming and cumbersome
  • Operator dependent, interpretation important
  • Cost/benefit questionable as a routine procedure

14
(No Transcript)
15
Causes and Prevention of Laparoscopic Bile Duct
Injuries
  • Analysis of 252 Cases From a Human Factors and
    Cognitive Psychology Perspective
  • Way et al
  • Ann Surg 2003

16
Causes and Prevention of Laparoscopic Bile Duct
Injuries
  • 97 cause of errors due to visual perceptual
    illusion, faults in technical skill only 3 of
    injuries
  • Misperception so compelling that in most cases
    surgeon did not recognize a problem
  • There are only a few points during lap chole
    where the complication causing errors occur

17
Causes and Prevention of Laparoscopic Bile Duct
Injuries
  • Solution 1
  • Change in conduct of the operation top down
    mobilization of gallbladder (haptic
    perception helps guide the surgeon to the cystic
    duct when it is difficult to see)
  • Easy to do open, not so laparoscopic

18
Causes and Prevention of Laparoscopic Bile Duct
Injuries
  • Solution 2
  • Cholangiography is currently the most practical
    technological aid for verifying the anatomy
  • Technology is a more likely source of help,
    current practice is selective not routine use

19
Causes and Prevention of Laparoscopic Bile Duct
Injuries
  • We especially recommend cholangiography when
    difficulties encountered
  • What is needed is an even simpler method of
    locating the course of the ductal system during
    the operation, something simpler than
    cholangiography or ultrasonography

20
Simple Cholangiography
  • GET RID OF RADIOLOGY!
  • CANNULATE THE GALLBLADDER NOT CYSTIC DUCT
  • USE CHOLANGIOGRAPHY THROUGHOUT THE OPERATION
  • Neff et al., BioLume

21
Cholangiography
  • Ideal Cholangiography
  • No-radiology, no apron, no c-arm, no wait
  • Simple (cholecystogram or Kumar clamp)
  • Easy playback option available
  • Repeatable throughout the case

22
Cholangiography
  • Proposal
  • Develop Bioluminescent Cholangiography

23
Cholangiography
  • Proposal
  • Develop Bioluminescent Cholangiography
  • Theoretical Advantages
  • Potential to meet criteria of ideal
    cholangiography (simple, no radiology)
  • Use current laparoscopic equipment

24
Bioluminescence
  • Consider
  • Non-heat producing light, enzymatic reaction
  • Non-toxic
  • Intra-abdominal cavity absolutely dark
  • Used as reporter with higher sensitivity than
    fluorescent dyes (less background)

25
(No Transcript)
26
(No Transcript)
27
Bioluminescent Cholangiography
  • Goal Define biliary anatomy and make
    cholecystectomy safer.

28
Assessment of Bioluminescent Cholangiography
  • A Postmortem Study of Surgical Anatomy
  • Philip T Neff MD, Dept. Surgery ELMC, Bruce
    Bryan MD, BioLume, Randall B. Murphy PhD BioLume
  • Approved Exempla IRB 200708

29
Assessment of Bioluminescent Cholangiography
  • Autopsy study using bioluminescent
    cholangiography and video-cameras and
    laparoscopic equipment

30
Assessment of Bioluminescent Cholangiography
  • Autopsy study using bioluminescent
    cholangiography and video-cameras and
    laparoscopic equipment
  • At time of open autopsy perform bioluminescent
    cholangiography and video record

31
Assessment of Bioluminescent Cholangiography
  • LABORATORY MODELS
  • Human Cadaver open with video-camera
  • Human Cadaver with laparoscopy
  • Pig Lab with laparoscopy

32
(No Transcript)
33
Bioluminescent Cholangiography
  • Bioluminescence can be used with many types of
    laparoscopes
  • The equipment will have to be modified optimized
    for bioluminescence

34
Bioluminescent Cholangiography
  • Convergence of technology, bioluminescence and
    laparoscopy
  • Public demands safety
  • Malpractice companies request safety
  • Surgical literature suggests that technological
    advances will solve problem (but does not state
    how!)

35
Bioluminescent Cholangiography
  • Future Clinical Studies
  • Phase I study, assess toxicity (non-toxic)
  • Phase II and III clinical human trials compare
    bioluminescent cholangiography with standard IOC
Write a Comment
User Comments (0)
About PowerShow.com