Presentation
Surgeons Struggle Interpreting ICG Fluorescence Imaging During Laparoscopic Cholecystectomy
DescriptionVisual misperception is a leading contributor to surgical errors when surgeons fail to correctly identify and interpret anatomical structures. To mitigate this risk, intraoperative imaging modalities are used during laparoscopic procedures to enhance visualization and reduce the likelihood of bile duct injury. Fluorescence imaging using indocyanine green (ICG) dye is commonly used in laparoscopic cholecystectomy to help surgeons visualize biliary structures. ICG fluorescence provides salient visual cues that may support identification of structures, though interpretation can vary with surgical expertise.
This study explored the influence of surgical expertise on accuracy of anatomical identification under white light and fluorescence imaging using ICG dye. We hypothesized that expert surgeons would exhibit improved accuracy in structure identification due to advanced perceptual and procedural skills.
Seventy-one surgeons viewed laparoscopic cholecystectomy video clips under white light and fluorescence imaging using ICG dye at the 2025 Society of American Gastrointestinal and Endoscopic Surgeons meeting. Participants were grouped as novices (n=29, postgraduate years 1-5), intermediates (n=20, senior residents and attendings with less than 10 years in practice), and experts (n=22, attendings with greater than 10 years in practice). Videos were presented with automated playback and consisted of eight 30-second clips and six additional clips with embedded pauses. During pauses, participants identified structures related to the critical view of safety, atypical anatomy, and incomplete dissections.
Responses were audio recorded, timed, and scored as correct, suggestive, or incorrect. Suggestive responses were defined as instances in which a participant proposing one or more likely structures without a definitive identification. Chi-squared tests of independence were performed for each question to examine the relationship between score and expertise level.
Significant associations between expertise level and score within the ICG video clips for identification of the cystic duct 〖(X〗^2= 10.57, p = 0.05), cystic artery 1 〖(X〗^2= 12.98, p = 0.01), common bile duct 〖(X〗^2= 10.34, p = 0.04), and common hepatic duct 〖(X〗^2= 10.77, p = 0.03) were identified. Experts were more likely to give suggestive responses with consideration of alternative structures rather than incorrect identifications. Intermediates often performed closer to experts, however their distributions were more variable. Novices were more frequently incorrect across conditions. No significant associations were found under white light, where accuracy was similar across all groups.
This study explored the influence of surgical expertise on accuracy of anatomical identification under white light and fluorescence imaging using ICG dye. We hypothesized that expert surgeons would exhibit improved accuracy in structure identification due to advanced perceptual and procedural skills.
Seventy-one surgeons viewed laparoscopic cholecystectomy video clips under white light and fluorescence imaging using ICG dye at the 2025 Society of American Gastrointestinal and Endoscopic Surgeons meeting. Participants were grouped as novices (n=29, postgraduate years 1-5), intermediates (n=20, senior residents and attendings with less than 10 years in practice), and experts (n=22, attendings with greater than 10 years in practice). Videos were presented with automated playback and consisted of eight 30-second clips and six additional clips with embedded pauses. During pauses, participants identified structures related to the critical view of safety, atypical anatomy, and incomplete dissections.
Responses were audio recorded, timed, and scored as correct, suggestive, or incorrect. Suggestive responses were defined as instances in which a participant proposing one or more likely structures without a definitive identification. Chi-squared tests of independence were performed for each question to examine the relationship between score and expertise level.
Significant associations between expertise level and score within the ICG video clips for identification of the cystic duct 〖(X〗^2= 10.57, p = 0.05), cystic artery 1 〖(X〗^2= 12.98, p = 0.01), common bile duct 〖(X〗^2= 10.34, p = 0.04), and common hepatic duct 〖(X〗^2= 10.77, p = 0.03) were identified. Experts were more likely to give suggestive responses with consideration of alternative structures rather than incorrect identifications. Intermediates often performed closer to experts, however their distributions were more variable. Novices were more frequently incorrect across conditions. No significant associations were found under white light, where accuracy was similar across all groups.
Event Type
Oral Presentations
TimeTuesday, March 2410:52am - 11:15am EDT
LocationMorgan
Simulation and Education