Chapter 3 Abstract Background Laparoscopic cholecystectomy (LC) is one of the most commonly performed laparoscopic procedures. Bile duct injury is a rare, but serious complication during this procedure, mostly caused by misidentification of the extra‐hepatic bile duct anatomy. Intraoperative cholangiography may be helpful to reduce the risk of bile duct injury; however this is not a common procedure worldwide. Near‐infrared fluorescence cholangiography (NIRFC) using indocyanine green (ICG) is a promising alternative for the identification of the biliary tree. Aim of this prospective observational study was to assess the feasibility and image quality of intermittent NIRFC during LC, using a newly developed laparoscopic fluorescence system. Methods Consecutive patients undergoing elective LC were included and received a single intravenous injection of ICG directly after induction of anesthesia. During dissection of the base of the gallbladder and the cystic duct the extra‐hepatic bile ducts were visualized using a dedicated laparoscope, which offers both conventional state‐of‐the‐art 38 imaging and fluorescence imaging. Intraoperative recognition of the biliary structures was registered at set time points, as well as the establishment of the critical view of safety. Results Fifteen patients were included between December 2011 and May 2012. ICG was visible in the liver and bile ducts within 20 minutes after intravenous administration and remained so up to approximately 2 hours, using the fluorescence mode of the laparoscope. The common bile duct and cystic duct could be clearly identified at an early stage of the operation and more important, significantly earlier than with the conventional camera mode. No per‐ or postoperative complications occurred as a consequence of ICG use. Conclusions Intermittent fluorescence imaging using a newly developed laparoscope and preoperative administration of ICG seems a useful aid in accelerating visualization of the extra‐hepatic bile ducts during laparoscopic cholecystectomy.
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