We appreciate the comments Dr Agarwal made recognizing fluorescent cholangiography1,2 as a promising technique for avoiding BDI during LC. Now that even inexperienced operators perform this procedure under the supervision of more experienced surgeons, BDI occurs mainly because of surgeons misperceiving the bile duct anatomy, rather than technical errors.3 Since fluorescent cholangiography can be a great help to surgeons for confirming the bile duct anatomy in real time and at any time during LC, this technique should help to avoid this serious complication. Furthermore, the fluorescent imaging technique may also be useful for identifying liver cancers during hepatectomy.4 We are conducting further studies to evaluate the efficacy of these fluorescent imaging techniques for enhancing the accuracy and safety of hepatobiliary surgery.
Ishizawa T, Bandai Y, Kokudo N. Patient Safety in Laparoscopic Cholecystectomy—Reply. Arch Surg. 2009;144(10):977-980. doi:10.1001/archsurg.2009.181