Fluorescence cholangiography during laparoscopic cholecystectomy attending surgeon was consulted. A structure was scored as ‘identified’ if its localization was confirmed with great certainty by the experienced surgeon. In case of the common bile duct this does explicitly not mean that it was surgically exposed, as this is contradictory to the CVS technique. During all laparoscopic cholecystectomies the full surgical procedure was recorded on DVD, thereby collecting both conventional and fluorescence images. After completion of surgery, length of time between the moment of ICG injection and the moment of introduction of the laparoscope until the first recognition of the following components were calculated, based on the intraoperative registration: cystic duct (CD), cystic artery (CA), common bile duct (CBD) and critical view of safety (CVS). Using conventional imaging the CBD is often not displayed; this is partly a result of the CVS technique. The mean ‘total NIRFC imaging time’ during the laparoscopic procedures was calculated based on the video recordings, in order to objectify how much longer the operation lasted due to application of the NIRFC technique. Patient undergoing elective laparoscopic cholecystectomy Data analysis of registered time measurements Figure 3.1 Flowchart of the NIRFC‐LC study procedures Quantitative analysis of NIRFC recordings Osirix® software was used to objectively assess the degree of ICG illumination in the extra‐hepatic bile ducts. The fluorescence images were analyzed by determining target‐ 41 Preoperative Intraoperative Postoperative Intravenous ICG injection directly after induction of anesthesia Video‐assessment for quantitative fluorescence image analysis Every 5‐10 minutes switch camera to ICG‐mode for fluorescence cholangiography, until CVS is established Visualization of biliary structures, respectively by conventional and ICG imaging, systematically registered Patient eligible for inclusion? Informed consent? Start laparoscopic procedure using conventional camera mode
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