Intraoperative cholangiography: past, present, and future

The extrahepatic biliary tree was first visualized in 1918 when Reich injected bismuth and petrolatum and defined a biliary fistula, thus opening the field for further studies of the biliary tree. Mirizzi recorded the first series of intraoperative cholangiography in 1932 using static films. Later, the mobile C-arm image intensifier using a TV monitor was reported in a series by Berci and colleagues in 1978. They emphasized the importance of using routine cholangiography in all laparoscopic cholecystectomies. This procedure can be performed through the cystic duct or through the gallbladder with excellent visualization of the anatomy of the extrahepatic biliary tree, including the potential of finding bile duct stones, stricture, and tumor, as well as defining the function and anatomy of Oddi's sphincter. Numerous benefits of this technique can be observed, including early definition of a bile duct leak or injury. X-ray resolution will continue to improve as well as three-dimensional imaging, and intraoperative magnetic imaging cholangiopancreatography may be developed as the future intraoperative cholangiogram.