Association of indocyanine green fluorescence navigation with extrahepatic biliary anatomy identification and operative efficiency in laparoscopic cholecystectomy: a retrospective cohort study.

BACKGROUND

Indocyanine green (ICG) fluorescence cholangiography may improve visualization of the extrahepatic biliary tree during laparoscopic cholecystectomy (LC). We examined whether its use was associated with biliary structure identification and with two time-based measures of operative efficiency in patients undergoing LC for benign gallbladder disease.

METHODS

Consecutive adult patients assessed for cholecystectomy for benign gallbladder disease between January and December 2025 were retrospectively screened. After the ICG-assisted and conventional white-light approaches had been explained, patients chose their preferred procedure; allocation was therefore non-random. The primary outcome was complete identification of the cystic duct, common bile duct, common hepatic duct, and cystic duct-common bile duct junction. The operating surgeon recorded identification during surgery, and a senior physician subsequently reviewed the operative video. Operative efficiency comprised time to achieve the critical view of safety (CVS) and total operative time. Drain placement was analyzed separately. Multivariable models were used to adjust for clinically relevant covariates.

RESULTS

Among 198 patients, 103 underwent ICG fluorescence-assisted LC and 95 underwent conventional white-light LC. All four biliary structures were identified in 91.3% of the ICG group and 56.8% of the white-light group (p < 0.001). Median time to CVS was 12.0 versus 21.0 min (p < 0.001), median operative time was 36.0 versus 48.0 min (p < 0.001), and drains were placed in 17.5% versus 38.9% of patients (p < 0.001). The associations remained significant after multivariable adjustment. No BDI, bile leakage, conversion to open surgery, reoperation, or ICG-related adverse event occurred.

CONCLUSION

ICG fluorescence use was associated with more frequent identification of extrahepatic biliary structures and shorter time to CVS and completion of LC. Because patients selected the surgical approach and assessment of anatomical identification included clinical judgment, these results should be interpreted as observational. They do not show that ICG reduces the risk of BDI. Prospective multicenter studies are needed.