The use of indocyanine green (ICG) fluorescence cholangiography for intraoperative bile duct visualization during laparoscopic cholecystectomy in situs inversus totalis
Bibliographic record
Abstract
Abstract Purpose Laparoscopic cholecystectomy (LC) in patients with situs inversus totalis (SIT) is technically challenging due to the reversed anatomical orientation of the thoracoabdominal organs, which can increase operative complexity and the risk of complications. Although the incidence of cholelithiasis and cholecystitis in SIT is similar to the general population, altered anatomy may lead to diagnostic and intraoperative uncertainty. We describe LC in a patient with SIT using intraoperative indocyanine green (ICG) fluorescence cholangiography to guide the identification of biliary structures. Methods Preoperative ultrasound, computed tomography, and magnetic resonance imaging are used to delineate anatomy and exclude biliary duct dilation or biliary anomalies. ICG (0.5 mL of 2.5 mg/mL) is administered intravenously one hour before surgery. A mirror-image port configuration is employed centered on the left hemiabdomen, with the surgeon standing on the patient’s right and the assistant on the left. During surgery, ICG fluorescence cholangiography is utilized intraoperatively to enhance visualization of the biliary anatomy and facilitate attainment of the critical view of safety. Results LC was successfully performed without complications. ICG imaging enabled clear identification of the cystic duct and common bile duct, mitigating the risks associated with anatomical variation in SIT. Conclusion LC in patients with SIT is rarely described and technically demanding due to reversed intra-abdominal anatomy. ICG fluorescence cholangiography is an innovative tool and valuable adjunct that improves biliary visualization and may enhance safety in complex anatomical settings.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".