Surgical outcomes of indocyanine green fluorescent cholangiography in emergency laparoscopic cholecystectomy performed by junior surgeons for acute cholecystitis.

BACKGROUND

Emergency laparoscopic cholecystectomy (LC) remains the preferred treatment for acute cholecystitis (AC); however, the prevalence of complications and negative outcomes increases in these emergency surgeries, especially when performed by junior surgeons. Recently, indocyanine green (ICG) fluorescent cholangiography has emerged as a useful technique for achieving adequate visualization of the biliary structures during LC, reducing the incidence of bile duct injury (BDI) and operative time. This study aims to evaluate the surgical outcomes of ICG fluorescent cholangiography during emergency LC performed by junior surgeons.

METHODS

A total of 156 consecutive patients (May 2023  to  December 2025) who underwent LC for AC were included, and all the surgeries were performed by junior surgeons. In total, 78 patients underwent ICG fluorescent cholangiography during LC (ICG group), while the remaining 78 patients underwent conventional LC with white light (non-ICG group). The demographic and clinical characteristics of these patients were retrospectively collected and analyzed, including gender, age, comorbidities, intraoperative BDI, conversion to open surgery, operative time, postoperative complications, postoperative hospital stay duration, and overall hospitalization cost. A multiple linear regression analysis was performed to examine whether ICG use was associated with the surgical outcomes.

RESULTS

The demographic characteristics of the ICG and non-ICG groups were similar. The patients in the ICG group had a significantly shorter operative time compared to those in the non-ICG group (65 min vs. 72.5 min, P  =  0.007). There were no significant differences between the groups for the other surgical outcomes, including BDI incidence, rate of conversion to open surgery, incidence of postoperative complications, postoperative hospital stay duration, and hospitalization cost. ICG use was found to be an independent factor associated with decreased operative time in the regression analysis.

CONCLUSIONS

The utilization of ICG fluorescent cholangiography during emergency LC could help junior surgeons shorten the operative time and may not increase the incidence of perioperative complications.