Intravenous cholangiography revisited.

The efficacy and safety of IVC with the new agent has not, in our opinion, been firmly established. In these circumstances we do not feel its routine use preoperatively in patients being considered for laparoscopic cholecystectomy is justified. We remain uncertain about its ultimate safety and are unconvinced that it is able, reliably, to demonstrate ductal anomalies which might increase the risk of iatrogenic injury. If imaging of ductal anatomy is important then it is best to obtain it intraoperatively. The radiologist often acts as an essential guide to the surgeon; as interventionist he frequently actually usurps the surgeon's role; and occasionally has to come to his rescue. In our opinion, he should not be asked to perform a procedure of unproven efficacy and uncertain safety in order to allow the surgeon willfully to abandon good surgical practice.