How to Improve Visualization During Laparoscopic Surgery in Jaundice Patients.

Dear Editor: Recent technological advancements have led to the introduction of high-quality cameras in laparoscopic surgery. The better view achieved with this new equipment along with the use of a high-definition monitor improved the quality of vision resulting in better precision of surgical performance. The longer the surgical procedure the greater the need for better visualization. In patients with jaundice, the visualization of the surgical field may be impaired by the tainting of the tissues by the accumulation of bilirubin. The yellowish pigmentation of the tissue may make it difficult to identify the anatomical structures and its margins may appear blurred. In order to overcome this problem, we have used a simple trick. At the beginning of the procedure we use the white balance adjustment from the camera using a white pad as a reference. As we enter the abdominal cavity with the laparoscope we can see the abdominal cavity tainted by the yellow pigment from hyperbilirubinemia (Figure 1A). 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 (Figure 1B and C), if the patient is Caucasian. The appearance of the abdominal cavity returns to was to be expected in a nonjaundiced 681890 SRIXXX10.1177/1553350616681890Surgical InnovationMachado et al letter2016