Indocyanine green (ICG) fluorescent cholangiography in laparoscopic cholecystectomy: Simplifying time and dose.

Fernando Pardo, Clara Gené, Jaime López-Sánchez, Alba Zárate, Francisco Espin, Manel Cremades, Jordi Navinés, Christian Herrero, Laura Vidal y Esteban Cugat.

This article aims to analyze and to simplify the optimal dose and time of intravenous indocyanine green (ICG) administration to achieve the identification of the cystic duct and the common bile duct (CBD). The CBD was better visualized in the at induction of anesthesia group (85.4%), in the hours before group (97.1%) (p = 0.002) and in the 1cc group (p = 0.011). When we analyzed the 1 cc group (n = 126) a greater visualization of the CBD was observed in the at induction of anesthesia group (86.7%) and in the hours before group (97.1%) (p = 0.027). Due to its simplicity and reproducibility, we suggest a dose of 2.5 mg administered 2-6 h before the procedure is the optimal. However, ICG administered 30 min prior to the surgery is enough for adequate visualization of biliary structures.

Doctors who have participated

Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dra. Zárate

Consultant in Hepatobiliopancreatic Surgery

Dr. Alba Zárate (Barcelona, 1989) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

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Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

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Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Dr. Navinés

Consultant in Hepatobiliopancreatic Surgery

Surgeon Specialist in General and Digestive System Surgery and Doctor of Surgery from the Universitat Autònoma de Barcelona.

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Robotic HBP surgery: a real opportunity with future potential.

Esteban Cugat y Fernando Pardo.

Fragmento de la Editorial: “La figura del mentor, que cumpla con las adecuadas cualidades técnicas, se antoja imprescindible para lograr una formación basada en la calidad quirúrgica y humana y ser el nexo de unión entre una generación de cirujanos que se tuvo que formar en cirugía abierta, en cirugía laparoscópica y ahora en cirugía robótica, con una generación más joven que ya crece paralelamente al mundo de la cirugía robótica”.

Doctors who have participated

Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Robotic cholecystectomy and transcystic common bile duct exploration with augmented reality glasses and indocyanine green in a patient with a cystic duct cyst.

Fernado Pardo, Laura Vidal, Manel Cremades y Esteban Cugat.

La coledocolitiasis puede ser tratada mediante cirugía mínimamente invasiva en aquellos pacientes con vesícula biliar in situ. Puede realizarse por coledocotomía o a través del conducto cístico, teniendo en cuenta que el acceso transcístico disminuye la morbilidad posoperatoria2. El acceso robótico representa una excelente alternativa y más aún en casos complejos. Se presenta un caso de colecistectomía robótica guiada con verde de indocianina y exploración transcística del colédoco. El cirujano asistente que manejaba el coledocoscopio realizó la intervención guiada con gafas de realidad aumentada. El tiempo operatorio fue de 150 minutos y el paciente fue dado de alta el primer día posoperatorio.

Doctors who have participated

Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

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Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Surgical treatment of the Median Arcuate Ligament Syndrome (MALS) using robotic platform.

Anna Vidal, Alba Zárate, Sara Sentí y Esteban Cugat.

Este síndrome está causado por la compresión extrínseca del tronco celíaco por bandas fibrosas del ligamento arcuato medio. Puede presentar importantes síntomas como dolor abdominal después de las comidas, vómitos y pérdida de peso.

Es este vídeo, elegido vídeo del mes por la revista Cirugía Española, se muestra en detalle el tratamiento quirúrgico mediante abordaje robótico y las ventajas de éste, siendo una técnica segura y eficaz realizada por equipos con experiencia.

Doctors who have participated

Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Dra. Sentí

Consultant in Hepatobiliopancreatic Surgery

Dr. Sara Sentí i Farrarons (Barcelona, 1992) is a Digestive  surgeon developing her clinical practice in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dra. Zárate

Consultant in Hepatobiliopancreatic Surgery

Dr. Alba Zárate (Barcelona, 1989) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Venous resection in pancreatic oncologic surgery: Different techniques for different situations.

Sara Sentí, Fernando Pardo, Maria Galofré, Francisco Espin, Eric Herrero Fonollosa, Maribel García-Domingo, Manel Cremades, Alba Zárate, Judith Camps, Jordi Navinés y Esteban Cugat.

Retrospective, cross-sectional and comparative analysis. We include 41 patients with malignant pancreatic lesions who underwent surgery with vascular resection due to vascular involvement, from 2013 to 2021.

The aggressive surgical treatment with venous resection in pancreatic malignant lesions to ensure R0 and its vascular reconstruction is a feasible technique, with an acceptable morbid-mortality rate and overall survival.

Doctors who have participated

Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dra. Sentí

Consultant in Hepatobiliopancreatic Surgery

Dr. Sara Sentí i Farrarons (Barcelona, 1992) is a Digestive  surgeon developing her clinical practice in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

View profile

Dra. Zárate

Consultant in Hepatobiliopancreatic Surgery

Dr. Alba Zárate (Barcelona, 1989) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

View profile

Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

View profile

Dr. Navinés

Consultant in Hepatobiliopancreatic Surgery

Surgeon Specialist in General and Digestive System Surgery and Doctor of Surgery from the Universitat Autònoma de Barcelona.

View profile

Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Long-term results of liver-first approach strategy in patients with advanced synchronous liver metastases from colorectal cancer.

Eric Herrero, María Galofré, Alba Zárate, Maribel García-Domingo, Judith Camps, Fernando Pardo, Francisco Espin y Esteban Cugat.

Retrospective descriptive analysis from a prospective database of hepatectomies from liver metastases (LM) from CRC in two centers. Between 2007-2019, 88 patients with CRC-ASLM (advanced synchronous liver metastases) were included in a LFA scheme. Bilobar (LM) was present in 65.9%, the mean number of lesions was 5.5 and mean size 42.7 mm. Response to treatment was assessed by RECIST criteria. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier survival curves.

In patients with CRC-ASLM the LFA allows control of the liver disease beforehand and an assessment of the tumor response to neoadjuvant chemotherapy, optimising the chance of potentially curative liver resection, which influences long-term survival.

Doctors who have participated

Dra. Zárate

Consultant in Hepatobiliopancreatic Surgery

Dr. Alba Zárate (Barcelona, 1989) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

View profile

Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

View profile

Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

View profile

Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

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Luces y sombras de la duodenopancreatectomía cefálica laparoscópica

Francisco Espin, María Isabel García-Domingo, Manel Cremades, Eric Herrero, Jordi Navinés, Judith Camps, Fernando Pardo y Esteban Cugat.

En este estudio se analizan 138 cirugías de duodenopancreatectomía (DPC) realizadas en un periodo de dos años (2017-2019). 23 DPC laparoscópicas, incluyendo patología benigna y maligna. Se valora la eficacia y seguridad y se compara con 31 DPC abiertas en el mismo periodo.

En un grupo seleccionado, la DPC laparoscópica puede realizarse de forma segura y eficaz si se realiza por grupos expertos en cirugía pancreática y en laparoscopia avanzada. Obtiene los mismos resultados que la cirugía abierta en el postoperatorio y es oncológicamente adecuada con menor estancia hospitalaria. Una selección adecuada de los pacientes, un programa establecido por pasos con una conversión laxa y precoz evita accidentes operatorios graves.

Doctors who have participated

Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

View profile

Dr. Navinés

Consultant in Hepatobiliopancreatic Surgery

Surgeon Specialist in General and Digestive System Surgery and Doctor of Surgery from the Universitat Autònoma de Barcelona.

View profile

Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

View profile

Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

View profile

Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

View profile

Laparoscopic and robotic distal pancreatectomy: The choice and the future.

Francisco Espin, María Isabel García-Domingo, Manel Cremades, Fernando Pardo, Laura Vidal, Eric Herrero, Jordi Navinés, Alba Zárate, Judith Camps y Esteban Cugat.

La pancreatectomía distal (PD) mínimamente invasiva (MIS) está actualmente bien establecida, ya sea mediante técnica laparoscópica (PDL) o robótica (PDR). De 83 PD realizadas entre enero del 2018 y marzo del 2022, se realizaron 57 casos (68,7%) mediante MIS, 35 PDL y 22 PDR (da Vinci Xi). Se evalúa la experiencia de ambos procedimientos y el valor del abordaje robótico. Se analizan en detalle los casos de conversión.

La PDMIS es un procedimiento seguro y factible en pacientes seleccionados. Una planificación quirúrgica y la implementación escalonada basada en la experiencia previa ayudan a afrontar procedimientos técnicamente exigentes. Se sugiere que la PDR podría ser el abordaje de elección en la pancreatectomía corporocaudal, no siendo inferior a la PDL.

Doctors who have participated

Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

View profile

Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

View profile

Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

View profile

Dr. Navinés

Consultant in Hepatobiliopancreatic Surgery

Surgeon Specialist in General and Digestive System Surgery and Doctor of Surgery from the Universitat Autònoma de Barcelona.

View profile

Dra. Zárate

Consultant in Hepatobiliopancreatic Surgery

Dr. Alba Zárate (Barcelona, 1989) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

View profile

Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Standardizing definitions and terminology of left-sided pancreatic resections through an international Delphi consensus

F. Espin in collaboration with International Guidelines for minimally invasive pancreàtic surgery.

In this study, new terminology for different types of left-sided pancreatic resection has been suggested by a large group of experts in the field of pancreatic surgery through a Delphi consensus process. Traditional DP refers to a heterogeneous group of left-sided pancreatic resections, whereas this new terminology distinguishes between the different types, with the aim of enabling better surgical reporting, understanding, and comparison.

Doctors who have participated

Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

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Realidad aumentada en cirugía hepato-bilio-pancreática. Una tecnología al alcance de la mano

Manel Cremades Pérez, Francisco Espin Álvarez, Fernando Pardo Aranda, Jordi Navinés López, Laura Vidal Piñeiro, Alba Zarate Pinedo, Ana María Piquera Hinojo, Sara Sentí Farrarons y Esteban Cugat Andorra.

La realidad aumentada es una tecnología que abre nuevas posibilidades en cirugía. Se presenta su implementación en una unidad de cirugía hepato-bilio-pancreática en relación con la planificación preoperatoria, el soporte intraoperatorio y la docencia. Para la planificación quirúrgica se han utilizado reconstrucciones 3D de la TC y de la RMN para hacer una evaluación de casos complejos, siendo la interpretación de la anatomía más precisa, y la planificación de la técnica más simple. A nivel intraoperatorio ha permitido la conexión remota holográfica entre especialistas, la sustitución de elementos físicos por elementos virtuales, y el uso de modelos virtuales de consulta y guía quirúrgica. En docencia se han impartido clases que incluyen la retransmisión de una cirugía con el soporte de elementos virtuales para una mejor comprensión por parte de los estudiantes. Siendo la experiencia satisfactoria, la realidad aumentada podría aplicarse en el futuro de la cirugía hepato-bilio-pancreática para mejorar sus resultados.

Doctors who have participated

Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

View profile

Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

View profile

Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

View profile

Dr. Navinés

Consultant in Hepatobiliopancreatic Surgery

Surgeon Specialist in General and Digestive System Surgery and Doctor of Surgery from the Universitat Autònoma de Barcelona.

View profile

Dra. Zárate

Consultant in Hepatobiliopancreatic Surgery

Dr. Alba Zárate (Barcelona, 1989) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

View profile

Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

View profile

Dra. Sentí

Consultant in Hepatobiliopancreatic Surgery

Dr. Sara Sentí i Farrarons (Barcelona, 1992) is a Digestive  surgeon developing her clinical practice in hepatobiliopancreatic surgery and pancreatic transplantation.

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