This video demonstrate Laparoscopic Cholecystectomy Full Length Skin to Skin Video with Infrared Cholangiography performed by Dr R K Mishra at World Laparoscopy Hospital. Infrared Cholegiography is performed by using Indocyanine Green during laparoscopic cholecystectomy surgery for gallbladder removal. Bile duct injury remains the most feared complication of laparoscopic cholecystectomy. Intraoperative cholangiography (IOC) is the current gold standard for biliary imaging and may reduce injury, but is not widely used because of difficulties of doing it. Near Infrared Fluorescence Cholangiography (NIRF-C) is a novel non-invasive method for real-time, radiation free, intra-operative biliary mapping during laparoscopic cholecystectomy. We have experienced that NIRF-C is a safe and effective method for identifying biliary anatomy during laparoscopic cholecystectomy. Indocyanine green is a cyanine dye is very popular and used in for many years in medical diagnostics. It is used for determining cardiac output, hepatic function, liver and gastric blood flow, and for ophthalmic angiography. Now the use of this dye in lap chole has improved the safety of this surgery by NEAR INFRARED FLUORESCENT CHOLANGIOGRAPHY.

Laparoscopic cholecystectomy (LC) has become the gold standard for treating gallbladder diseases, particularly symptomatic gallstones and cholecystitis. Advances in imaging and minimally invasive techniques have enhanced the safety and precision of this procedure, with near-infrared (NIR) cholangiography emerging as a revolutionary tool for real-time biliary visualization.

Introduction

Traditionally, LC relies on standard white-light laparoscopy to identify biliary anatomy. However, bile duct injuries remain a serious complication. Near-infrared cholangiography, using indocyanine green (ICG) dye, allows surgeons to visualize the cystic duct, common bile duct, and surrounding structures in real-time, reducing the risk of injury and improving surgical outcomes.

Full-Length Skin-to-Skin Video

A full-length skin-to-skin video provides a complete visual guide, showing the entire operative procedure from initial incision to final closure. This approach is particularly beneficial for surgical trainees and practicing surgeons who wish to understand not just the critical steps but also the workflow, ergonomics, and decision-making during the operation.

Key highlights of the video include:

1. Patient positioning and port placement – Demonstrating optimal trocar placement for ergonomics and access.

2. Initial dissection and exposure – Safe mobilization of the gallbladder with attention to anatomical landmarks.

3. Near-infrared cholangiography integration – Real-time visualization of biliary anatomy after intravenous ICG administration, highlighting the cystic duct and common bile duct.

4. Critical view of safety – Step-by-step identification and confirmation of the cystic duct and artery before clipping and division.

5. Gallbladder removal and hemostasis – Safe extraction and meticulous inspection for bleeding or bile leakage.

6. Closure and post-operative care – Final skin closure and summary of post-operative considerations.

Advantages of NIR Cholangiography in LC

• Enhanced safety – Reduces the risk of bile duct injury by clearly delineating biliary anatomy.

• Real-time guidance – Helps in identifying anatomical variations intraoperatively.

• Minimally invasive – Adds precision without additional incisions or radiation exposure.

• Educational value – Full-length videos with NIR provide a learning platform for surgeons at all levels.

Conclusion

Laparoscopic cholecystectomy with near-infrared cholangiography represents a significant advancement in minimally invasive surgery. Full-length skin-to-skin videos offer an invaluable resource for surgical education, allowing viewers to observe the entire procedure in a realistic operative setting. Integrating NIR imaging into routine LC can enhance patient safety, improve outcomes, and serve as a powerful training tool for the next generation of surgeons.