Laparoscopic cholecystectomy is the gold standard procedure for treating symptomatic gallstone disease and many other gallbladder pathologies. Over the last three decades, it has replaced open cholecystectomy due to advantages such as reduced postoperative pain, shorter recovery time, early mobilization, and better cosmetic outcomes. A “skin to skin” laparoscopic cholecystectomy video demonstrates every surgical step in real time, beginning from the creation of ports to the closure of incisions. Such a comprehensive surgical video, when combined with near infrared (NIR) cholangiography, provides both a learning opportunity for surgeons and a safety mechanism for avoiding bile duct injury.

Importance of Full-Length Skin to Skin Video

In surgical training and education, “skin to skin” videos play a crucial role. Unlike edited or shortened demonstrations, full-length recordings show each stage of the procedure in its natural sequence. This allows surgeons to understand practical aspects such as trocar insertion, intraoperative difficulties, troubleshooting techniques, and safe dissection. For learners, such videos are invaluable because they display realistic operative challenges, time management, and decision-making processes.

Furthermore, full-length documentation serves as an authentic reference for surgical audits, medico-legal purposes, and quality improvement initiatives. It enables trainees and practicing surgeons to appreciate nuances of instrument handling, ergonomics, energy source application, and anatomical exposure.

Surgical Technique in a Full-Length Video

A typical laparoscopic cholecystectomy video begins with induction of general anesthesia and proper patient positioning. The patient is placed in a supine position with reverse Trendelenburg and slight left tilt to optimize exposure of the right upper quadrant.

Creation of Pneumoperitoneum and Port Placement
Pneumoperitoneum is established using either the closed Veress needle technique or an open (Hasson) method. Four ports are placed: a 10 mm umbilical port for the camera, a 10 mm epigastric port for working instruments, and two 5 mm ports in the right subcostal region for traction and assistance.

Initial Survey and Exposure
The liver and gallbladder are inspected. Adhesions, if present, are released. The gallbladder is retracted cephalad and laterally to expose Calot’s triangle.

Dissection of Calot’s Triangle
Careful dissection is performed to identify the cystic duct and cystic artery. The “critical view of safety” must be achieved before clipping or dividing any structure.

Application of Clips and Division
Once anatomy is clearly defined, clips are applied to the cystic duct and cystic artery, which are then divided.

Gallbladder Separation
The gallbladder is separated from the liver bed using electrocautery or an energy device. Hemostasis is secured.

Specimen Retrieval and Closure
The gallbladder is extracted through the epigastric or umbilical port. Finally, the pneumoperitoneum is released, and port sites are closed.

In a full-length video, each of these steps is captured without interruption, providing complete insight into operative flow and timing.

Role of Near Infrared Cholangiography

One of the most significant advancements in laparoscopic cholecystectomy is the introduction of near infrared (NIR) fluorescence cholangiography using indocyanine green (ICG). This technique allows real-time visualization of the biliary tree without the need for traditional intraoperative X-ray cholangiography.

Technique: ICG is administered intravenously before surgery. Under near infrared light, the dye fluoresces, highlighting biliary structures such as the cystic duct, common bile duct, and hepatic ducts.

Advantages:

Provides dynamic, real-time mapping of biliary anatomy.

Reduces risk of common bile duct injury.

Shortens operative time compared to conventional cholangiography.

Avoids radiation exposure.

When integrated into a full-length laparoscopic cholecystectomy video, NIR cholangiography enhances both safety and educational value by clearly demonstrating biliary structures at critical steps of dissection.

Educational Benefits

For surgical residents, fellows, and practicing surgeons, watching a skin-to-skin laparoscopic cholecystectomy video with NIR cholangiography offers several advantages:

Visualization of Anatomy: Learners can repeatedly observe how to obtain the critical view of safety while simultaneously understanding biliary anatomy under fluorescence.

Understanding Complications: Full-length videos often display unexpected challenges such as adhesions, bleeding, or difficult gallbladders, showing how to manage them effectively.

Improved Decision-Making: Surgeons can appreciate when to proceed with standard dissection, when to switch to fundus-first approach, or when to convert to open surgery.

Enhanced Confidence: Exposure to realistic, unedited operative scenarios prepares surgeons for independent practice.

Clinical Relevance

The integration of full-length operative videos with NIR cholangiography also improves patient outcomes. With clearer visualization of biliary anatomy, the likelihood of bile duct injury is reduced. Moreover, patients benefit from safer surgery, reduced postoperative morbidity, and faster recovery.

Hospitals and academic centers increasingly utilize such recordings for training, workshops, and global sharing of surgical expertise. The availability of high-definition laparoscopic cameras and advanced imaging systems has further improved the clarity and educational impact of these videos.

Conclusion

A full-length “skin to skin” laparoscopic cholecystectomy video with near infrared cholangiography is an invaluable tool for modern surgical practice and training. It captures every critical detail of the operation, from initial incision to final closure, while simultaneously demonstrating enhanced biliary anatomy visualization through fluorescence imaging. This combination not only aids in the prevention of bile duct injuries but also enriches the educational experience of trainees worldwide. With continued advancements in imaging and minimally invasive surgery, such videos will remain a cornerstone of surgical education, safety, and global knowledge sharing.