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Tirelli et al. Mini-invasive Surg 2021;5:15 https://dx.doi.org/10.20517/2574-1225.2021.04 Page 3 of 4

the epigastrium to pull the bottom of the gallbladder upward and the trocar in the mesogastrium to perform
the monopolar hook dissection. The assistant, on the other hand, was positioned between the legs to permit
holding the scope with the left hand and helping with the right hand the surgeon pulling the infundibulum
of the gallbladder outwards. This position allowed the surgeon to obtain the best possible angle to perform a
correct dissection of the gallbladder, with easy preparation of the cystic duct and the cystic artery. The
administration of ICG (indocyanine green) was carried out about 1 h before the surgery and not previously
because, in our department, we try to reduce hospital stays as much as possible we generally hospitalize
[9]
patients for this type of surgery on the same day of the operation. As suggested by Tebala et al. , ICG
injection could be performed the day before the surgery in order to reach an optimal concentration in the
bile, but there is no clear evidence in the literature that the administration of ICG 1 h before surgery is not
already sufficient. This case demonstrated that administration 1 h before surgery could be sufficient, and the
images in the video prove it. Indocyanine green fluorescence angiography can help the surgeon identify the
structures in cases of non-regular anatomy such as this. In conclusion, in patients with SVI, laparoscopic
cholecystectomy can be safely performed and ICG fluorescence can be helpful for identifying anatomical
structures.

DECLARATIONS
Authors’ contributions
Conception and design: Tirelli F, Grieco M, Biondi A, Belia F, Persiani R
Manuscript writing: Tirelli F, Belia F
Video editing: Grieco M, Tirelli F, Belia F
Final approval of manuscript: Tirelli F, Grieco M, Biondi A, Belia F, Persiani R

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable

Consent for publication
Not applicable

Copyright
The Author(s)2021

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