Chapter 3 In this study fluorescence imaging of the arterial anatomy was not conducted. Simultaneous NIR fluorescence imaging using ICG of bile ducts and arterial anatomy is however possible20,21. Our patients mostly had uncomplicated cholecystolithiasis (11/15 patients). We plan to investigate the NIRFC technique for complicated cholecystectomies as well, when better and earlier identification of Calot’s triangle is even more desirable, e.g. acute cholecystitis, status after biliary pancreatitis and Mirizzi syndrome. This study showed that faster recognition of essential biliary structures during laparoscopic cholecystectomy was obtained after a single preoperative intravenous administration of iodine‐free ICG. Using a newly developed laparoscopic fluorescence device the surgeon was able to easily switch between conventional and fluorescence camera mode. Nevertheless, a relatively small number of patients were included for this study and fluorescence imaging for confirmation of the arterial anatomy was not performed. Future research in a larger population will focus on this part. The NIRFC technique can possibly become an excellent aid for surgical trainees in conducting safe (i.e. less adverse events) laparoscopic cholecystectomy. Conclusion The first application of a novel available laparoscopic fluorescence system for intermittent fluorescence cholangiography using iodine‐free ICG during elective laparoscopic cholecystectomy is successful and offers clinical potential. In this study it proved to be a useful aid to obtain earlier and clearer recognition of the biliary anatomy. 46
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