How to Improve Visualization During Laparoscopic Surgery in Jaundice Patients.

Marcel Autran Machado, MD, FACS, Rodrigo C. Surjan, MD, Tiago Basseres, MD, Fabio F. Makdissi, MD

Surg Innov 2017 Feb;24(1):95-96. doi: 10.1177/1553350616681890




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Recent technological advancements have led to the introduction of high-quality cameras in laparoscopic surgery. In patients with jaundice, the visualization of the surgical field may be impaired by the tainted of the tissues by the accumulation of bilirubin. The yellowish pigmentation of the tissue may difficult the identification of anatomical structures and its margins may appear blurred.
In order to overcome this problem, we have used a simple trick. As we enter the abdominal cavity with the laparoscope we can see the abdominal cavity tainted by the yellow pigment from hyperbilirrubinemia. We then perform a “white” balance using a yellow pad to adjust the color of the video, the so-called “yellow balance”. Another way to do it is to use the patient’s skin (Figs. 1B, 1C), if the patient is Caucasian. The appearance of the abdominal cavity returns to was to be expected in a non-jaundiced patient.
White balance is the process of removing unrealistic color casts, so that tissue which appears white in real are rendered white in the video. The “yellow balance” uses the same principle to remove the excess of the yellow color from the bile pigment. This adjustment can be done with several shades of yellow until we achieve a comfortable view.
This simple trick is routinely used in our laparoscopic surgical procedures such as pancreatoduodenectomy or hepaticojejunostomy in jaundice patients. We recommend the use of this simple color adjustment to improve surgical visualization during these complex procedures.