Chapter 4 in 13 of 15 patients (87%). In two patients the cystic artery was already ligated in an earlier stage of dissection. In the total operation time (median 90 minutes) 1 up to 2 minutes was spent for the intraoperative use of the fluorescence technique. As a preventive measure, in 3/30 patients the gall bladder was punctured and drained during surgery to facilitate manipulation; this did neither compromise fluorescence imaging of the biliary tract nor the postoperative course. A B Figure 4.2 A. WL image (left) and corresponding fluorescence image (right) taken at initial exposure of the 58 liver hilum. The liver and extra‐hepatic bile ducts are illuminated bright blue: cystic duct (continuous arrow) and common bile duct (interrupted arrow) are indicated; B. WL image (left) and corresponding fluorescence image (right) at establishment of Critical View of Safety, snap‐shots taken 10 seconds after repeat ICG injection. The cystic duct (continuous arrow) and cystic artery (interrupted arrow) are clearly exposed. Target‐to‐background ratio Mean TBR at establishment of CVS (median 63 minutes after ICG administration) amounted to 5.6 for the CD, 6.8 for the CBD and 4.8 for the CA.
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